Optional_2023 Board Resources

(i) Direct Compensation Arrangements . Such arrangements involve direct remuneration between a designated health services entity and a referring physician (or immediate family member). In addition, physicians who are owners of their practice "stand in the shoes" of their practice for purposes of analyzing compensation arrangements between the practice and the DHS entity. (ii) Indirect Compensation Arrangements . Such arrangements exist when between the referring physician and the DHS entity there is 1) an unbroken chain of any number of entities that have financial relationships; 2) the aggregate compensation received by the physician from the closest link in the chain with which the physician has a direct financial relationship varies with or takes into account the volume or value of referrals or other business generated by the physician for the entity providing DHS; and 3) the entity providing DHS must have the proper mens rea in the form of actual knowledge, reckless disregard, or deliberate ignorance that the physician's aggregate compensation that varies with or takes into account the volume or value of referrals or other business generated by the referring physician for the DHS entity. (c) Designated Health Services . The following designated health services

fall under the above prohibitions: 21 (i)

Clinical laboratory services;

(ii) Physical therapy services, occupational therapy services, and speech pathology services; (iii) Radiology services, including MRI, CT scan, and ultrasound services (including nuclear medicine); (iv) Radiation therapy services and supplies; (v) Durable medical equipment and supplies; (vi) Parenteral and enteral nutrients, equipment, and supplies; (vii) Prosthetics, orthotics, and prosthetic devices and supplies; (viii) Home health services; (ix) Outpatient prescription drugs; (x) Inpatient and outpatient hospital services; and (xi) Outpatient speech-language pathology services.

2.2 Penalties . Stark is a payment statute, which means that claims submitted for prohibited referrals are not payable. 22 Civil monetary penalties also exist for of up to about $24,000 per designated health service plus treble the claimed amount and potential exclusion from all federal health care programs. 23 Additionally, False Claims Act liability may attach for submitting or causing the submission of claims contrary to the Stark Law's billing rule. While there is strict liability under the Stark Law for overpayment, but a "knows or should know" intent

21 42 U.S.C. § 1395nn(h)(6). 22 42 U.S.C. § 1395nn(g). 23 Id .