BC Advantage - 2025 Issue 5

Understanding Internal Self-Referrals

Healthcare regulations outline legal risks related to internal self-referrals, making it important for both physicians and healthcare organizations to be informed about these issues. While internal referrals may seem like a natural part of integrated healthcare systems, they are heavily regulated under federal and state laws, particularly the Stark Law and the Anti-Kickback Statute (AKS). Violations of these laws can result in significant penalties, including fines, exclusion from federal healthcare programs, and even criminal liability.   Stark Law: A Strict Liability Framework   Stark Law, codified at 42 U.S.C. §1395nn, prohibits physicians from referring Medicare or...

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