PHYSICIAN SELF-REFERRAL: HCFA ISSUES PROPOSED REGS
The federal government has issued 405 pages of proposedThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
regulations clarifying a 1993 law designed to "prohibit doctors
from referring Medicare patients to outpatient services in which
they have an economic interest," the Wall Street Journal reports.
Since the so-called "Stark II" law -- named after its sponsor,
Democratic Rep. Pete Stark of California -- was enacted, it has
"become a huge source of confusion in the health care industry"
because "federal bureaucrats didn't promptly spell out how the
law would be applied in various complex settings." The delay led
to erratic enforcement "and frustration on the part of health-
fraud investigators, who aren't always sure what constitutes a
Stark II violation."
The new regulations should help make clear the complicated
law, the Journal reports. "They've tried to give order to what
has been a hodge-podge of inconsistencies," said Alice Gosfield,
a Philadelphia health care attorney. Mary Grealy, senior
Washington counsel at the American Hospital Association, said she
believes the proposed regulations will make it easier "for
physicians and hospitals to work together in integrated systems."
Under the proposed guidelines, doctors would be allowed to accept
gifts valued under $50, "with an annual maximum of $300," if
there was no "direct link to patient referrals." In addition,
"[p]ay arrangements consistent with 'fair market value' are
permissible under Stark II" as long as "pay isn't tied to the
volume or value of a doctor's referrals." Orthopedists will be
allowed to provide patients with crutches, "as long as the
doctors don't profit from the transaction."
NOT DONE YET
The regulations will be available for public comment later
this year, but it may be "two years before the review process is
complete." The AHA reportedly wants more guidance on "what
hospitals can do to recruit young doctors after they finish their
training." Michael Peregrine, an attorney with Gardner, Carton &
Douglas, said, "Of all the basic health care laws, this is the
one that's least understood. I welcome the additional guidance,
but it's going to be a scramble to keep up with what it means"