Essay On Employee Exception

Employee Exception The Ethics in Patient Referrals Act, more commonly known as the Stark Law, and the Medicare Anti-Fraud and Abuse Amendment of 1977, more commonly known as the Anti-Kickback Statute, prohibit healthcare providers from paying any compensation to those who make referral to the providers of healthcare services that can be reimbursed by Medicare or other federally funded health care programs. 42 U.S.C. § 1395nn (2000). Social Security Act § 1128B(b), 42 U.S.C. § 1320a-7b(b) (2000). There are, of course, certain exceptions to this rule.

One very important and hotly litigated exception that appears in both the Stark Law and the Anti-Kickback Statute is the Employee Exception. The Employee Exception essentially makes certain referral or remuneration transactions, that would normally be considered a violation of one or both of these statutes, kosher as long as the transaction involves a bona fide employee. The problem is that recent

Further, in an effort to provide some guidance to a solution, this paper will explore how, through some simple adjustments to one or both of the exception’s language and with the implementation of a physician and market rating system, the government and physician employers can avoid confusing and expensive litigation in the future.

The Stark Law The Ethics in Patient Referral Act, herein referred to as the Stark Law, was enacted in 1989. The Stark Law prohibits physicians with ownership interest in and/or receives compensation from certain healthcare organizations from referring patients to those organizations for designated health services reimbursable by Medicare or other federal healthcare programs. 42 U.S.C. § 1395a. The law was introduced to address the problem of excessive medical tests being ordered by physicians in private