Opinion ID: 2746816
Heading Depth: 2
Heading Rank: 1

Heading: Stark Statute

Text: In its most general terms, the Stark statute prohibits doctors from referring Medicare patients to a hospital if those doctors have certain specified types of “financial relationships” with that hospital. See 42 U.S.C. § 1395nn(a)(1)(A). And, in turn, the Stark statute prohibits that same hospital from presenting claims for payment to Medicare for any medical services it rendered to such referred patients. See id. § 1395nn(a)(1)(B). Although the Stark statute broadly defines “financial relationships,” the statute contains numerous exceptions to that definition. See id. § 1395nn(a)(2); id. 8 Case: 13-11859 Date Filed: 10/30/2014 Page: 9 of 41 § 1395nn(b)–(e) (listing exceptions to the broad definition of “financial relationship” such as “bona fide employment relationships”). For the limited purposes of their motion to dismiss, the Defendants do not argue that an exception to the Stark statute’s broad definition of “financial relationship” applies to the financial-referral incentives alleged in Mastej’s complaint. Rather, the Defendants concede that the complaint’s factual allegations about the neurosurgeon payments and golf benefit—taken as true at this motion-todismiss stage—satisfy the Stark statute’s definition of “financial relationship” between a doctor and a hospital. Where such a Stark-defined “financial relationship” exists—as the Defendants concede for the purposes of their motion to dismiss—a doctor “may not make a referral to the [hospital],” and the hospital “may not present or cause to be present[ed] a [Medicare] claim.” See id. § 1395nn(a)(1). For purposes of this motion, the Defendants also do not contest that they could not seek Medicare reimbursement for medical services (even though actually rendered to patients) if those patients were referred by doctors in exchange for the particular financial incentives alleged in the complaint. 9 Case: 13-11859 Date Filed: 10/30/2014 Page: 10 of 41