A single referral arrangement can put a physician’s entire practice under federal review. A Stark Law defense lawyer represents health care providers when compensation structures and billing relationships become the focus of a government investigation.
The financial structures that keep a practice running are the same ones that draw federal attention when a review begins. A financial and health care compliance defense lawyer helps providers get ahead of the record before a position becomes fixed.
At Bertolino LLP, we have defended Texas professionals for over 20 years and represented thousands of licensed providers across the state. We don’t send form letters. Reach out to our Client Success Liaison to schedule a complimentary consultation.
What the Stark Law Actually Prohibits
Our Texas civil malpractice defense lawyers understand how a civil inquiry can pull federal referral rules into the picture. When investigators begin reviewing claims data, a financial arrangement that supported the practice for years can suddenly require a defense.
Under the Stark Law, a physician cannot refer Medicare or Medicaid patients to an entity where the physician or an immediate family member holds a financial interest. The statute does not require proof of intent, and referrals that fall outside an applicable Stark Law exception can create significant compliance exposure.
The government can deny payment and require repayment of amounts already received, with civil monetary penalties assessed on a per-claim basis. For providers with a high referral volume, that math adds up fast.
How Stark Law Investigations Begin
A qui tam complaint, or whistleblower complaint, is how many of these cases begin. Someone with inside knowledge, such as a former employee, business partner, or competitor, may file a complaint under seal, and the government takes its time deciding whether to step in. The provider finds out only after that decision has been made.
The whistleblower path is not the only one that leads to a federal investigation. Medicare contractors review billing data through their own oversight process, and a referral relationship that conflicts with the statute’s exceptions can generate an enforcement referral based solely on that review.
Federal attorneys may have spent months with the financial records before a provider sees the first letter. A defense has to account for that. The question is not how the investigation started but what the government has already decided about the arrangement.
What the Defense Actually Examines
Dozens of exceptions exist under the Stark Law, and a defense that identifies the right one can resolve exposure well before litigation becomes necessary. The documentation in place when the arrangement was first formed determines whether that exception applies.
The financial arrangement, as it was documented, is where our review begins. Contract terms and compensation records from when the relationship was structured give the defense something concrete to work with.
The statute’s reach is not unlimited. Whether the Stark Law applies to a given arrangement depends on the nature of the health service involved, the geographic scope of the referral relationship, and the structure of the entity at the center of the arrangement.
When the False Claims Act Enters the Picture
Federal prosecutors reviewing a Stark Law matter will also look at whether any prohibited referrals resulted in Medicare claims submitted for payment. When they find that connection, the False Claims Act applies, and treble damages and civil monetary penalties become available to the government.
Two separate legal frameworks running at the same time means two separate sets of risks. A statement made in response to Stark Law allegations can surface in the False Claims Act case, and a position taken in one proceeding can create problems in the other if the defense is not coordinated from the start.
Our approach to these matters reflects that reality. Our Stark Law defense attorneys monitor both exposure tracks and keep the record consistent so that a position taken in one context does not create a new problem in another.
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What Our Stark Law Defense Attorneys Look for in the Record
The record is what a Stark Law defense gets built on. Our job is to ensure the documentation supporting the arrangement is accurate, complete, and organized before federal scrutiny demands it.
The documents we examine include:
- Compensation agreements and fair market value assessments.
- Ownership and investment documentation for any related entities.
- Billing records and claims submission histories.
- Physician employment contracts and productivity formulas.
- Board minutes, organizational charts, and corporate formation documents.
- Any internal compliance reviews or audits conducted before the investigation began.
That review drives every decision that follows. Whatever the documentation does not support needs to be addressed before a response goes to the government, because federal reviewers will find it regardless.
The Role of Self-Disclosure
A compliance review that identifies a Stark Law issue sometimes provides providers with access to the Centers for Medicare & Medicaid Services Self-Referral Disclosure Protocol. Voluntary disclosure through that process can reduce repayment obligations, but the decision to use it requires the same careful analysis as any other defense decision.
The threshold question is what the government already knows. The strength of any exception defense, and the likely direction of the case if the provider waits, both factor into whether disclosure serves the provider’s interests or introduces new ones.
We evaluate the disclosure question the same way we evaluate the rest of the defense. Moving quickly in the wrong direction creates more exposure than it resolves, and the goal is the best available outcome given the full record.
Protecting Your License While the Federal Case Moves Forward
A Stark Law investigation puts more than the federal civil matter at risk. A physician’s Texas Medical Board standing, hospital credentialing status, and Medicare and Medicaid participation can all be subject to separate review while the federal case is still active, and those proceedings proceed on their own schedules.
Statements made to federal investigators surface in licensing proceedings. Settlement terms and repayment agreements appear on credentialing disclosures, and federal health care program exclusion can put a practice at risk even after the civil matter has been resolved.
We monitor both proceedings. Keeping the written record consistent across forums helps prevent a resolved federal matter from generating a new licensing problem after the fact.
Your Next Move Starts With One Conversation
The record in a Stark Law matter begins to form before most providers realize a response is due. Prompt attention to a government letter about referral relationships or billing arrangements is where the defense work begins.
Our Stark Law defense lawyers start by assessing what the government has and what the record currently supports. From there, we outline the available defense options before submitting any formal response.
Bertolino LLP has defended Texas health care providers and licensed professionals since 2003. We stand by you through every stage of the process. Reach out to our Client Success Liaison today to schedule a complimentary consultation.
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