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    Comparison Chart of Anti-Kickback Safe Harbors and Stark Exceptions -- Intra-Family Rural Referrals

    Intra-Family Rural Referrals – Current as of March 2021

    Stark
    Stark exception related to both ownership/investment and compensation for intra-family referrals in rural areas 42 CFR 411.355(j)

    Anti-Kickback
    [No comparable safe harbor]

    Services are provided pursuant to a referral from a referring physician to his or her immediate family member or to an entity furnishing designated health services with which the immediate family member has a financial relationship.

     

    The patient who is referred resides in a rural area.

     

    No other person or entity is available to furnish the services in a timely manner in light of the patient's condition within 25 miles of or 45 minutes transportation time from the patient's residence; except in the case of services furnished to patients where they reside (for example, home health services or in-home DME), no other person or entity is available to furnish the services in a timely manner in light of the patient's condition.

     

    The referring physician or the immediate family member must make reasonable inquiries as to the availability of other persons or entities to furnish the designated health services. However, neither the referring physician nor the immediate family member has any obligation to inquire as to the availability of persons or entities located farther than 25 miles of or 45 minutes transportation time from the patient's residence.