What constitutes a “referral” for purposes of the Stark ban?
Stark broadly defines “referral” to include a request by a physician for an item or service payable under Medicare or Medicaid (including the request by a physician for consultation wit another physician and any test or procedure ordered or performed by such other physician), or a request by a physician for the establishment of a plan of care that includes the provision of a DHS. The definition of “referral,” does not include services personally performed by a referring/ordering physician (but not services furnished by employees of, or other members of the same group practice as, the ordering physician). Accordingly, physicians who personally perform the DHS that they order for their patients can structure arrangements without worrying about potential Stark violations.
