Stark Law prohibits physician self-referral for Medicare/Medicaid patients when what condition exists?

• A. There is a financial relationship between the physician (or family member) and the service
• B. There is no financial relationship at all
• C. It applies only to private insurance plans
• D. It requires the physician's license to be renewed annually

Answer: (A)

The key idea here is that the Stark Law restricts physician self-referral for Medicare/Medicaid patients whenever there is a financial relationship between the physician (or a family member) and the service being referred to. A financial relationship can be ownership or investment interest, or a compensation arrangement. If such a relationship exists and the physician refers patients to the designated health service, the referral may violate the Stark Law unless a safe harbor exception applies. This focuses on how financial ties can influence referrals, not on patient insurance type or on the physician’s license status. If there’s no financial relationship, or if the service isn’t a designated health service or isn’t billed to Medicare/Medicaid, the prohibition doesn’t apply.