Texas Stark Law Violation Defense Attorney

At Cogdell Law Firm, we provide experienced legal counsel to health care providers navigating the complexities of Stark Law violations throughout Texas. When a provider faces a Stark Law violation allegation, it can have serious civil and criminal consequences.

The Stark Law is a crucial federal statute designed to prevent conflicts of interest by prohibiting physicians from referring patients to entities with which they or their immediate family members have financial relationships.

Our firm boasts over 40 years of combined experience in health care fraud defense, serving clients throughout Texas with a record of significant case successes. Led by Dan Cogdell, a renowned trial attorney, our practice has gained extensive recognition for handling high-profile health care fraud cases, often at the federal level.

Elements of a Stark Law Violation

Stark Law violations occur when physicians refer patients for designated health services (DHS) to entities where there is a financial relationship, either direct or indirect. DHS includes a wide range of services such as laboratory tests, physical therapy and imaging services.

The federal physician self-referral law prohibits physicians from referring patients for specific medical services to entities with which they have a financial relationship. Federal prosecutors or regulators refer to Section 1877 of the Social Security Act when establishing a Stark Law violation.

To constitute a violation, key elements must be present:

• Physician referral: The law applies only when a physician is involved.
• Designated Health Services (DHS): The referral must be for designated health services such as clinical laboratory tests, radiology and imaging, or outpatient prescription drugs.
• A financial relationship with the entity providing the services: Prosecutors must show the physician has a financial relationship — such as ownership interests, investment interests or compensation arrangements — with the entity providing the services.
• The services are billed to a federal health care program: The services must have been covered by programs such as Medicare or Medicaid.

The Stark Law is considered a strict liability statute, meaning the government does not need to prove that the physician intended to break the law. Multiple state and federal agencies may be involved in the investigation, including the Department of Justice, the Centers for Medicare & Medicaid Services, the Texas Medicaid Fraud Control Unit and the Texas Health and Human Services Commission Office of Inspector General.

Since these cases are complex, our skilled lawyer can conduct a careful legal analysis and help protect your rights and your professional license.

When Do Stark Law Violations Occur?

Stark Law violations apply to physicians and designated health services that are billed to Medicare or Medicaid. Examples of Stark Law violations include:

• A physician referring patients to a diagnostic center in which they have an ownership interest.
• Referring to a practice where a family member is employed and receives financial benefits from referrals.
• Leasing office space from a company owned by a family member under non-fair-market-value terms.
• Investing in companies that provide medical devices used in the physician's practice.
• Accepting compensation that varies with the number of referrals made to a particular specialist.

Facing Stark Law allegations requires the experience of a seasoned attorney who understands the intricacies of health care laws and can effectively protect your professional interests.

Common Examples of Stark Law Violations

In Texas, several common scenarios frequently lead to allegations of Stark Law violations, such as:

• Physicians referring patients to medical facilities in which they have an ownership interest — for example, a doctor who owns a diagnostic imaging center routinely referring Medicare or Medicaid patients there for MRIs or CT scans.
• Improper compensation arrangements structured to reward referrals for designated health services.
• Investment relationships with laboratories, durable medical equipment suppliers or home health agencies.

Our experienced defense attorney can defend you against these allegations and help protect your profession.

Can You Face Criminal Charges for Stark Law Violations?

While the Stark Law primarily triggers civil penalties, associated misconduct could lead to criminal charges. These can arise from related offenses such as Medicare and Medicaid fraud, certain types of billing fraud and violations of the False Claims Act. It is crucial to address Stark Law concerns proactively to mitigate the risk of escalating into criminal liabilities.

Civil penalties for Stark Law violations can include substantial fines, repayment of claims and exclusion from federal health programs. Criminal charges related to health care fraud could result in more severe consequences, including imprisonment and larger fines. Aside from civil and criminal penalties, you may face damaging reputational harm.