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Stark Law deadline set for Jan. 1

Certain imaging services subject to notification provision of law

A change to an existing law will require dentists who supply certain imaging services to give Medicare and Medicaid patients written notification of alternative suppliers.

Two publications offer help in understanding fraud law, frequently asked legal questions

A new publication is available to help dentists understand the Stark Law and other federal fraud and abuse laws.

The U.S. Department of Health and Human Services Office of the Inspector General has published “A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse.” The book discusses five fraud and abuse laws; practitioner relationships with payers, vendors and fellow providers; compliance programs and where to go for help. For more information on the book, click here. To download a printable copy, click here.

Fraud and abuse laws can affect dentists even if they don’t bill Medicare or Medicaid. Penalties for violations include fines, exclusion from federal health care programs, and in some cases even criminal prosecution. A mere inadvertent violation can have devastating consequences. Health care fraud and abuse laws prohibit certain business practices that may be acceptable in other industries.

The recently enacted federal health care reform legislation includes new tools and increased funding to fight health care fraud. For example, the act requires health care providers who identify a Medicare or Medicaid overpayment to report and return it with a written explanation of the reason for the overpayment within 60 days.Retaining an overpayment for longer than 60 days violates the False Claims Act.

The American Dental Association publication “Frequently Asked Legal Questions” was recently updated and offers answers to nearly 190 questions commonly asked by members. The spiral bound book and CD-ROM (l756) is $89.95 for members and $134.95 for nonmembers. The e-book (L756D) is $59.95 for members and $89.95 for nonmembers. To order, call the ADA Member Service Center at 1-800-947-4746 or visit www.adacatalog.org.

The new requirement takes effect Jan. 1, 2011.
 
A tweak to the federal physician self-referral law, the Stark Law, means a dentist whose practice supplies certain MRI, CT or PET imaging services may be required to notify Medicare and Medicaid patients that they can obtain the services from another supplier. Notification in the form of a written list of five alternative imaging suppliers in a 25-mile radius must be given to the patient at the time of the referral for the service.

Penalties for violating the Stark Law include not being paid for claims for designated health services, fines and/or being excluded from participating in federal health care programs. Violating the Stark Law may also constitute a violation of the federal Anti-Kickback Statute, which carries criminal penalties. A number of states have also enacted physician self-referral and anti-kickback statutes.
 
“While this new requirement does not apply to routine dental radiographs, any dental practice that provides, or is considering providing, CT, MRI or PET imaging services should be aware of this change to the Stark Law,” said Dr. Stephen Glenn, chair of the ADA Council on Dental Practice. 
The Stark Law prohibits a dentist from referring patients for designated health services payable by Medicare or Medicaid to people or companies where the dentist or a member of the dentist’s immediate family has a financial relationship. There are exceptions to the law. 

Designated health services include clinical laboratory services; physical therapy services; occupational therapy services; outpatient speech-language pathology services; radiology and certain other imaging services; radiation therapy services and supplies; durable medical equipment and supplies; parenteral and enteral nutrients, equipment and supplies; prosthetics, orthotics and prosthetic devices and supplies; home health services; outpatient prescription drugs; and inpatient and outpatient hospital services.

To help dentists understand this change to the Stark Law, the ADA Legal Division has written an article that provides more comprehensive and detailed information on the new requirement.