Medical Auditing Practice Exam

The Stark Statute applies to which of the following scenarios?

1. Physicians who refer patients to entities with which they have a financial relationship

2. Healthcare providers who receive payments from insurance companies

3. All hospitals providing Medicare services

4. Only non-profit providers of healthcare services

The correct answer is: Physicians who refer patients to entities with which they have a financial relationship

The Stark Statute, which is also known as the Physician Self-Referral Law, specifically targets situations where physicians refer patients to entities in which they have a financial interest. This statute is designed to prevent conflicts of interest and ensure that medical decisions are made based on the best interests of the patient rather than financial incentives. In this context, if a physician has a financial relationship with a healthcare entity—such as ownership or compensation agreements—and refers patients to that entity, it raises concerns about potential overutilization of services or unnecessary referrals purely for financial gain. The Stark Statute regulates these relationships by imposing strict requirements on disclosures and prohibiting certain types of referrals, creating a framework aimed at maintaining ethical practices within the healthcare system. Thus, the answer appropriately identifies the scenario to which the Stark Statute applies by highlighting the relationship between physicians and the entities they may refer patients to, reflecting the core intent of the law. Other options relate to broader scenarios such as payments from insurance companies, which are not directly governed by the Stark Statute, or apply more generally to all hospitals or only to non-profit providers, rather than focusing specifically on the financial relationships inherent in physician referrals.