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How To Write A Qui Tam Complaint: A Tutorial Series

Article #8 The Stark Law Violation Law Section

Posted on Sunday, December 23, 2012, 04:54:51 PM Eastern Time USA by JOSEPH J. PAPPACODA, ESQ..




In your Medicare-Federal False Claims Act Complaint you may have specific fraud allegations related to Stark Law Violations. If you do, the Stark Law Violation Law Section of the Qui Tam Complaint may look something like this (Section numbers and paragraph numbers should be tailored to fit your Complaint):

"XX. THE STARK LAW

77. The Stark Law, codified at 42 U.S.C. § 1395nn, prohibits physicians from referring patients to entities furnishing designated health services, otherwise reimbursable under Medicare and/or Medicaid, when the physician (or an immediate family member of the physician) has a financial relationship in the referral entity, subject to certain permissible exceptions codified in 42 U.S.C. § 1395nn.

78. 42 U.S.C. § 1395nn (a) provides in pertinent part:

§1395nn. Limitation on certain physician referrals

(a) Prohibition of certain referrals

(1) In general

Except as provided in subsection (b) of this section, if a physician (or an immediate family member of such physician) has a financial relationship with an entity specified in paragraph (2), then—

(A) the physician may not make a referral to the entity for the furnishing of designated health services for which payment otherwise may be made under this subchapter, and

(B) the entity may not present or cause to be presented a claim under this subchapter or bill to any individual, third party payor, or other entity for designated health services furnished pursuant to a referral prohibited under subparagraph (A).

(2) Financial relationship specified

For purposes of this section, a financial relationship of a physician (or an immediate family member of such physician) with an entity specified in this paragraph is—
(A) except as provided in subsections (c) and (d) of this section, an ownership or investment interest in the entity, or

(B) except as provided in subsection (e) of this section, a compensation arrangement (as defined in subsection (h)(1) of this section) between the physician (or an immediate family member of such physician) and the entity.

An ownership or investment interest described in subparagraph (A) may be through equity, debt, or other means and includes an interest in an entity that holds an ownership or investment interest in any entity providing the designated health service.” 42 U.S.C. § 1395 nn (a) (2012)

79. The term designated health services [aka “DHS”] is defined in 42 U.S.C. § 1395nn (h)(6) as follows:

(6) Designated health services

The term “designated health services” means any of the following items or services:

(A) Clinical laboratory services.
(B) Physical therapy services.
(C) Occupational therapy services.
(D) Radiology services, including magnetic resonance imaging, computerized axial tomography scans, and ultrasound services.
(E) Radiation therapy services and supplies.
(F) Durable medical equipment and supplies.
(G) Parenteral and enteral nutrients, equipment, and supplies.
(H) Prosthetics, orthotics, and prosthetic devices and supplies.
(I) Home health services.
(J) Outpatient prescription drugs.
(K) Inpatient and outpatient hospital services.
(L) Outpatient speech-language pathology services.

42 U.S.C. § 1395nn (h)(6)(2012)(see also 42 C.F.R. § 411.351) [Emphasis added]

80. A violation of the Stark Law results in an overpayment, even if a party does not intend to engage in unlawful conduct. The Stark Law is intended to prevent healthcare providers from taking actions for the purpose of financial benefit to themselves instead of for the patient’s benefit."

These averments can be and should be modified or supplemented for your particular case. The idea here is to be instructive to the Court and US Attorney on the issue of Stark Law Violations and why they implicate 31 U.S.C. § 3729, et seq.

Prohibited self referral of patients is rampant in The Medicare Program System in 2012.

For further information on the False Claims Act, or your specific Quitam case, please contact Attorney Joe Pappacoda directly at 954-560-2616, or use the link found at USFraudCases.com.

Copyright 2012 Law Offices Of Joseph J. Pappacoda, Fort Lauderdale, Florida 33301.



The blog material on this page is provided for reference only, and it is not to be construed as legal advice in any fashion. For more information, please see the written DISCLAIMER.

 

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