The Stark Law prohibits physicians and other medical professionals from referring some patients to facilities with which the provider has a financial relationship. The consequences of violating the self-referral law are severe. Even if you made an honest mistake, you could be convicted and face license revocation, significant fines, and business damage.
You need a trusted criminal defense lawyer with in-depth knowledge of federal and Washington healthcare fraud laws to handle your defense. Our Seattle healthcare criminal defense lawyer has extensive experience defending physicians and other medical providers in healthcare fraud cases. We represent clients facing allegations of false claims, medical kickbacks, and Stark Law violations.
For over 30 years, Attorney Jennifer Horwitz has provided aggressive defense representation to protect our clients’ rights, freedom, and professional reputations. She handles complex federal investigations and prosecutions.
Contact Jennifer Horwitz Law to schedule a confidential consultation with a healthcare fraud defense lawyer for self-referral allegations.
How Our Seattle Healthcare Fraud Attorney Can Help Defend Against Self-Referral
Hiring an experienced Seattle healthcare fraud defense lawyer early in your case gives you the best chance of mounting a strong defense. When you hire our award-winning Seattle criminal defense attorney, we will provide skilled legal services, including:
- Reviewing the allegations against you to assess your risk and potential criminal penalties
- Take immediate action to intervene in a government investigation, if necessary
- Conduct a thorough investigation into the charges against you to gather evidence and information to assist in your defense
- Explain your legal options and discuss various strategies for your defense
- Analyze evidence, documents, and information to determine the strengths and weaknesses in your case
- Work with the leading experts in their fields to strengthen the evidence in your case
- Assist you in making informed decisions regarding your defense to avoid making errors that could harm your interests
- Aggressively negotiate a plea agreement that provides a discreet resolution to your case to protect your professional license and reputation
- Prepare your case as if we are going to trial to ensure we are prepared for all potential scenarios
Attorney Jennifer Horwitz is a graduate of Harvard Law School. Express.com named her one of Seattle’s Best Criminal Defense Attorneys in 2022. Forbes recognized her as a top attorney in Seattle, and she is one of Super Lawyer’s Top Women Attorneys of 2024.
Early legal intervention helps protect your legal options. Call Jennifer Horwitz Law to schedule an initial consultation with a Seattle healthcare fraud defense attorney.
Understanding Self-Referral Violations Under the Stark Law in Washington State
The Stark Law, also known as the Federal Physician Self-Referral Law, is codified in 42 U.S. Code §1395nn. There are five elements of the Stark Law:
- A doctor or other medical provider, not including nurse practitioners or other advanced practice nurses;
- Make a referral for a patient;
- To a person or entity other than the doctor;
- For a designated health service;
- When the doctor or their immediate family member has a financial interest with or in the entity or individual receiving the referral.
Designated health services (DHS) include physical therapy, laboratory services, durable medical equipment, radiology services, home health services, and much more. A financial interest or relationship can mean an investment or ownership interest. It also includes compensation arrangements, such as a doctor receiving payment from the entity.
Common examples of self-referrals that can violate the Stark law include:
- Referring patients to an imaging center that the doctor owns
- Arranging labs through a facility that the doctor’s family owns
- Referring patients for physical therapy to a center owned by the doctor’s spouse
- A hospital pays a doctor a salary that is substantially higher than the average salary for doctors because the doctor refers patients to the hospital
There are exceptions to the Stark Law that could apply in some situations. For instance, referring a patient to a family member for designated health services in rural areas. Another exception is referring a patient to a physician within the same practice or for in-office ancillary services, such as drawing blood for labs.
How Does the Stark Law Differ from the Anti-Kickback Statute?
Even though the laws are closely related and aim to reduce unnecessary medical expenses and procedures, there are some distinct differences. The Stark Law applies to designated health services billed to Medicaid or Medicare by an entity in which the referring provider has an interest. The Anti-Kickback Statute applies to all medical providers and their personnel for all federal programs.
The Stark Law imposes civil penalties for a violation. However, the Anti-Kickback Statute includes both civil penalties and criminal punishments. A violation of the Anti-Kickback Statute could result in a federal prison sentence.
Intent is another difference between the laws. Prosecutors must prove intent to obtain a criminal conviction under the Anti-Kickback Statute. However, the Stark Law is a strict liability law. The prosecution does not need to prove that a physician intended to violate the law. In other words, you could face civil penalties for a self-referral even though you did not intend to do anything wrong.
What Happens After You’re Accused of a Self-Referral Violation in Washington State?
An investigation for a self-referral violation could result from a whistleblower complaint or a qui tam False Claims Act case. The government may initiate an investigation after federal probes or audits.
When you are being investigated for violations of the Stark Law, you can expect to receive subpoenas and requests for interviews. It is in your best interest to discuss your legal rights and obligations with a Seattle self-referral defense attorney immediately upon receiving a subpoena or notice of an investigation. Talking to a government agent or investigator without legal representation is not in your best interest.
You may be contacted by one or more government agencies or departments about a Stark Law violation. The Centers for Medicare & Medicaid Services (CMS), the Department of Health & Human Services Office of Inspector General (OIG), and the Health Care Fraud Unit of the Department of Justice (DOJ) are charged with enforcing the law. Doctors may also be referred to the Washington Medical Commission for licensing action if they are convicted of a self-referral violation.
What Are the Penalties for a Stark Law or Self-Referral Violation in Washington?
Because the Stark Law is civil, you face civil fines if you are convicted of violating self-referral laws. Fines under the Stark Law can be as high as $15,000 per prohibited referral. The fine for circumvention schemes is $100,000.
You may also be ordered to pay restitution and could be excluded from the Medicare and Medicaid programs. If the Anti-Kickback Statute is involved, you could also face criminal penalties.
Working with an attorney who has experience with healthcare fraud defense is crucial. An experienced lawyer understands the importance of preparing a defense that encompasses additional charges that could be related to a self-referral violation. Additional charges could be filed under the Anti-Kickback Statute and Washington State laws for medical assistance fraud and/or false or misleading statements.
Common Defenses to Allegations of Self-Referrals in Washington State
Regardless of whether you are guilty or were wrongfully accused of self-referrals, you deserve an aggressive, comprehensive defense. At Jennifer Horwitz Law, our legal team explores all potential defenses.
Attorney Jennifer Horwitz customizes a defense strategy based on the evidence and factors of your case. Potential defenses to self-referrals include:
- A consultation does not violate the Stark Law because of an exception
- The referral did not involve a designated health service
- You fall within the bona fide employment exception for referrals
- The referral falls under one of the statutory exceptions
- Lack of financial benefit or absence of a financial relationship
- There was a misunderstanding related to the business relationship
We help you gather evidence to support your defense, such as copies of contracts and referral arrangements. Documentation about compliance protocols to demonstrate compliance with Stark Law exceptions and requirements.
Talk to a Seattle Healthcare Fraud Defense Lawyer Today
Anyone associated with referrals could be accused of violating the Stark Law, including physicians, practice managers, business owners, and billing managers. If you have been accused of making self-referrals, contact Jennifer today for an immediate and confidential legal consultation.