Stark Law violations can result in significant reputational damage along with financial penalties for hospitals, which is why it is important for hospitals to understand the restrictions and exceptions detailed under the Stark Law.
Background: If anything of value directly or indirectly provided to a physician (their family members or office staff) may implicate the federal law prohibiting certain referrals by physicians, 42 U.S.C. § 1395nn (the “Stark Law”) and the federal anti-kickback statute, 42 U.S.C. § 1320 a-7b (b) (the “Antikickback Statute”). The Hospitals organized under Section 501(c)(3) of the Internal Revenue Code of 1986 are also subject to certain restrictions and reporting obligations in connection with such gifts and incidental benefits.
As per the limits posted by CMS on non-monetary compensation and medical staff incidental benefits, the Stark Law provides two exceptions for relatively minor remuneration provided to a referring physician. The exceptions are:
- A hospital may provide up to the non-monetary compensation limit for items or services (exceptions are cash or cash equivalents) provided to a physician. For calendar year 2016, the aggregate limit is $392, which is same as 2015.
- The medical staff incidental benefits exception permits a hospital and other entities with medical staffs to provide “low value” items and services to its medical staff (or a particular specialty of the medical staff). For calendar year 2016, the maximum value of incidental benefits is $33, which is same as 2015.
The following table displays the compensation limits for each calendar year since 2010:
|Calendar Year||Non-monetary compensation limit in accordance with §411.357(k)||Medical staff incidental benefit in accordance with §411.357(m)(5)||Percentage Change in the CPI-U|
|CY 2010||$355||Less than $30||-1.3%|
|CY 2011||$359||Less than $30||+1.1%|
|CY 2012||$373||Less than $31||+3.9%|
|CY 2013||$380||Less than $32||+2.0%|
|CY 2014||$385||Less than $32||+1.2%|
|CY2015||$392||Less than $33||+1.7%|
|CY 2016||$392||Less than $33||+0.0%|
For the CY January 1, 2016, the compensation limit for the exception at § 411.357(k) is $392, and the value of any medical staff incidental benefits to be furnished in compliance with the exception at § 411.357(m)(5) is less than $33 per occurrence of the benefit.
Want to know how to track non-monetary compensations to physicians around the year? Our expert speaker Jay P. Anstine, JD, will discuss how to logistically track NMC along with what items/services qualify for NMC, in an audio session.