Effective March 1st, certain providers choosing to self-disclose Stark Law violations must use forms updated by the Centers for Medicare & Medicaid Services (“CMS”).
Stark Law – Overview
The Stark Law prohibits a physician from referring a Medicare beneficiary for designated health services to an entity with which the physician (or the physician’s immediate family member) has a financial relationship, unless an exception applies. See 42 U.S.C. § 1395nn. Providers who are aware that they have violated the Stark Law at any point within the most recent six-year period may self-report violations in accordance with CMS’s self-referral disclosure protocol (“SRDP”). See 42 C.F.R. § 1003.140; 42 C.F.R. § 401.305(f). Once CMS acknowledges receipt of a provider’s SRDP submission, the provider’s obligation to report and return overpayments within 60 days is suspended. See id. at § 401.305(b)(2)(ii).
New/Revised SRDP Forms
CMS has revised certain SRDP forms to streamline parts of the self-disclosure process.
1. Group Practice Information Form – New. CMS has developed a new Group Practice Information Form that enables a group practice, as a whole, to identify which elements of the group practice definitional requirements under 42 C.F.R. § 411.352 it failed to satisfy. (The exception for in-office ancillary services does not apply to DHS referred within and performed by a physician practice that does not fully satisfy the Stark Law’s definition of a ‘group practice’.) The form also requires the submission of an Excel spreadsheet that includes the following information for each physician who made prohibited referrals during the applicable lookback period:
- Name and NPI
- Statement of whether the referring physician is an owner, employee, or independent contractor of the practice
- Statement of whether the referring physician received compensation that failed to comply with the group practice requirements under the Stark Law
- Period of non-compliance
Use of this single form replaces the prior requirement that each physician of the practice submit a separate Physician Information Form. However, the Group Practice Information Form should not be used when a practice satisfies all group practice definitional requirements, but its DHS fails to meet the requirements of an exception codified at 42 C.F.R. § 411.355 (including the exception for physician services at § 411.355(a) and the exception for in-office ancillary services at § 411.355(b)). In such cases, separate Physician Information Forms should be completed and submitted for each referring physician, consistent with historical practice.
2. Physician Information Form – Revised. If an arrangement does not satisfy a Stark Law exception and the referring physicians stand in the shoes of their physician organization (per 42 C.F.R. §§ 411.354(c)(1) or 411.354(c)(2)), then in lieu of submitting a Physician Information Form for each such physician, a single Physician Information Form may be submitted so long as it contains a separate listing of (i) the names and NPIs of each ‘shoe-standing’ physician, i.e., of each physician deemed to have the same non-compliant compensation arrangement with the DHS entity as his or her physician organization, (ii) the period(s) of non-compliance for each such physician, and (iii) other relevant information (e.g., if one of the physicians redeemed her equity in the physician organization on a certain date, terminating her ‘shoe-standing’ status as of such date).
3. Signed Certification – Revised. The signed certification may now be submitted electronically without the need to mail a separate hard copy of the signed certification to CMS. Therefore, all documents in connection with the SRDP can be submitted electronically by email to 1877SRDP@cms.hhs.gov.
In sum, certain parts of the SRDP process are more streamlined by enabling physician practices to submit a single form in lieu of multiple and nearly identical forms, and by permitting electronic submissions without a hard copy mailed separately.
Our team members can assist with the SRDP process by detangling its requirements and by preventing the submission of superfluous paperwork to CMS. If you have any questions about the SRDP process or recent changes to the SRDP’s required forms, please contact any member of our Health Care Team for assistance.