How to Report a Stark Violation

Named after Congressman Pete Stark, who initially sponsored the bill, the Stark Law was enacted to prevent physicians or their immediate family members from benefiting financially from Medicare/Medicaid patient referrals for designated health services (DHS). These services include, but are not limited to, outpatient pharmacy services, clinical laboratory services, and imaging services. Physicians may not refer a patient to a DHS with which they or immediate family members may have a financial relationship or investment. This law prevents overutilization of services as well as a captive referral system that may inhibit competition from other providers.

Instructions

1. Go to the Centers for Medicare and Medicaid Services website to review information on the Stark law as well as common billing codes used for designated health services. The CMS website keeps an updated list of these codes according to Medicare and Medicaid guidelines.

2. Write down date, time, place, patient involved and services that you believe are in violation of the Stark Law. Any official documents such as physician orders for referral or billing codes will allow you to clarify information clearly in your report.

3. Write down the names of any witnesses as well as their contact information for reference.Two or more witnesses to a violation are always better than just one.

4. Report a Stark violation to The Office of the Inspector General. Go to the OIG website and select "report fraud" to report a Stark violation online. You may also call the OIG Hotline at 800-HHS-TIPS. The OIG accepts any tips on Stark violations.

5. Withhold any information that may identify you directly from your report if you choose to report your complaint anonymously.

Tips & Warnings

• Provisions in the federal whistleblower protections protect your personal information from being shared with anyone other than those investigating the case.

• The Stark Law contains more than 20 exceptions. Review this law carefully.

References

• AAFP: The Stark Truth About the Stark Law
• Stark Law Information
• Centers for Medicare and Medicaid Services: Physician Self Referral

Resources

• Office of the Inspector General: Reporting Fraud
• Whistleblower Laws