Stark Law Enforcement Predicted to Rebound, Providers Encouraged to Reassess Risk

Despite Stark Law enforcement seeming to have gone relatively quiet, according to a recent article by The National Law Review (NLR), the strict liability statute’s six-year lookback period is ticking, and renewed compliance scrutiny is expected before those periods expire. With significant penalties at stake, the NLR article recommends that providers take advantage of the lull to reduce risk and review their compliance practices regarding physician arrangements and designated health services.

Updates to the Stark Law rule have been lagging since 2023, with the Centers for Medicare and Medicaid Services (CMS) offering no updated regulations for the 2023, 2024, 2025, or 2026 Hospital Outpatient Prospective Payment System. Noticeably, CMS hasn’t updated its Stark Law FAQs since 2021. While this trend could be construed as an abandonment of enforcement priority, the NLR cautions providers against complacency. Citing the risk magnitude of the potential settlement or penalty amounts and the six-year statute of limitations, NLR warns that even technical missteps could trigger future investigations; therefore, providers should be proactive in auditing their arrangements during this window.

Where Stark is concerned, common pitfalls for providers include paying physicians above fair market value, maintaining incomplete or missing contracts, structuring arrangements based on referral volume or value, and allowing improper physician ownership or investment.

BFMV is experienced in reviewing and designing fair market value and commercially reasonable healthcare arrangements that meet the volume or value standard. Contact us for hourly consulting or FMV opinion engagements.

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