Stark General Exception

Remuneration for physicians’ services that are furnished by or under the supervision—at a level that satisfies applicable Medicare supervision requirements—of the referring physician herself, another physician in the referring physician’s group practice, or an independent contractor physician who is furnishing patient care services to the referring physician’s group practice. For purposes of Stark, a "group practice must meet the following conditions:
 

  1. single legal entity;

  2. at least 2 physicians (whether employees or direct or indirect owners);

  3. each physician who is a member of the referring physician’s group practice furnishes the full range of patient care services she routinely provides through the group’s joint facilities;

  4. at least 75% of the total patient care services furnished by each of the members of the group are furnished inside the group;

  5. expenses and income of the referring physician’s group are distributed in accordance with a method set and in place prior to the receipt of payment for the services giving rise to the overhead expenses or producing the income;

  6. unified business with centralized decision making and consolidated billing, accounting and financial reporting;

  7. no compensation based on volume or value of referrals; and

  8. at least 75% of the referring physician’s group’s physician-patient encounters are conducted by members of the referring physician’s group (the group cannot have too many independent contractor physicians).

 

See www.starkgrouppractice.com for more information about Stark-compliant physician group practices.

8. Physician Investments in Their Own Practices/Physician Services

Sources: 42 C.F.R. § 411.355(a) and 42 C.F.R. 411.352