Extract to table

Each of these DHS categories is subject to the Stark Law's referral prohibition, and each referral relationship must be covered by a valid exception for the resulting claims to be properly submitted to Medicare or Medicaid

Each exception contains multiple elements, all of which must be satisfied for the exception to protect a given arrangement

The exception requires: (i) a written arrangement signed by the parties; (ii) specification of the services to be provided; (iii) a term of at least one year (or a compliant holdover arrangement); (iv) aggregate compensation set in advance, consistent with FMV, and not determined in a manner that takes into account the volume or value of referrals; and (v) the services must be reasonable and necessary for the legitimate business purposes of the arrangement

The entity furnishing DHS pursuant to a prohibited referral is required to refund to CMS any amounts collected from the Medicare program for such services

§ 1320a-7k(d), an entity that has received an overpayment from the Medicare or Medicaid program is required to report and return the overpayment within 60 days of identifying the overpayment

Accordingly, each physician employment relationship must satisfy the employment exception at 42 C