Sources: 42 C.F.R. § 411.355(j)

18. Intra-Family Rural Area Referrals

Services provided pursuant to a referral from a referring physician to his or her immediate family member or to an entity furnishing DHS with which the immediate family member has a financial relationship, if all of the following conditions are met:
 

  1. The patient who is referred resides in a rural area;

  2. In light of the patient’s condition, there is no other DHS entity available to provide the referred DHS in a timely manner within 25 miles or 45 minutes transportation time from the patient’s residence;

  3. In the case of services furnished to patients where they reside (for example, home health services or DME), no other person or entity is available to furnish the services in a timely manner in light of the patient's condition; and

  4. The financial relationship between the referring physician or immediate family member and the DHS entity does not violate the anti-kickback statute or any billing or claims submission laws or regulations.

Stark General Exception