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Someone help me understand. Is the Stark law saying that if my Community doctor refers me to Community Hospital or Surgery Center that their not allowed to bill Medicare for those services because he or she has a financial relationship with them? Is it saying referring them is not the problem, but rather that their being compensated for those referrals? I would expect them to refer other Community services and doctors weather they are being directly paid or not for doing so. It would seem unnecessary to have to pay extra for something that would probably happen anyway (Intracompany referrals). I have been a Community customer for many years and I expect every referral, test or surgery to be kept within the Community Health Network whenever possible. I understand that the ultimate goal would be to empower patients to be better consumers of healthcare services, but with Medicare what choices do you have except what they give you?
No. What the Stark Law apparently makes illegal is paying physicians excessively (i.e. well above market pay) in return for the physicians’ referrals to the health system.
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This is what the ex-CFO and Justice Department are alleging.
It’s also alleging some services were referred to the hospital (higher charges, higher costs, higher reimbursement) that could have been done at outpatient physician practices (lower charges, lower costs, lower reimbursement).
The patient care coordinator where I used to work verbally told us to stop referring patients an orthopedic group outside of Community because they were in a dispute with that group. They threw away flyers with the address & phone number to that outside group. If a patient wanted to be seen by a specialist who was a non Community provider that was their right. I think that was unethical.
It is not wrong to refer patients within a network, but the patient should always have a choice in who they are referred to. Providers should not be getting bonuses or kickbacks for those referrals.
Who were the doctors involved and what if any action has been taken concerning them?
That’s what I would like to know.