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Richard - Bizlaw
Richard - Bizlaw, Attorney
Category: Business Law
Satisfied Customers: 10648
Experience:  30 years of corporate, litigation and international law
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We are a skilled Nursing Facility in rural ND. We have a

Customer Question

We are a skilled Nursing Facility in rural ND. We have a Critical access Hospital in our town but are 40 miles from the next Hospital which is also Critical access.
Our Hospital has recently hired a new CEO.
When we have someone in our facility on Medicare A and they require labs, x-rays etc. Is it legal for the Hospital and the Nursing Home to have an arrangement for the cost of these tests?
We have been paying the fee schedule for years but new administration states the Stark law will consider this an anti-kick back and we could both be fined for being out of compliance.
Our Fiduciary Intermediary for Medicare tells us there is not a law that prohibits us from this.
Thank you
Submitted: 1 year ago.
Category: Business Law
Expert:  Richard - Bizlaw replied 1 year ago.

Hello, my name is ***** ***** I will try to help you. Please remember I just report or interpret the law, so the outcome may not be what you hoped for.

The fee schedule that you refer to is that schedule different from what the medicare fee is for the services in question? Is there a common ownership between the hospital and your service? Does the doctor ordering the tests have an ownership interest in both your facility and hospital?

Customer: replied 1 year ago.
The answer to all questions is no,
Expert:  Richard - Bizlaw replied 1 year ago.

I will do some research and get back to you tomorrow.

Expert:  Richard - Bizlaw replied 1 year ago.

Your intermediary is correct. The STARK law really deals with doctors referring to entities they control. That is not applicable in your situation. The anti kick back is about paying consideration for referral of health care business. You are paying the standard price for patient services that is equal to the medicare fee schedule. You are not paying extra consideration to the hospital for the services so there is no kickback direct or indirect.

If I have answered all your questions, please positively rate my answer as that is how I receive credit. If you have more questions, please let me know. If the answer was especially helpful you can provide a bonus.

Expert:  Richard - Bizlaw replied 1 year ago.

I responded to your question a couple of days ago. If you have more follow up questions let me know. If not, please highly rate my answer as that is how I get credit for working on your answer.