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Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 41

You are excited – getting off of crutches and onto a prosthetic leg is a rehabilitation step that at the same time makes you nervous and opens the door toward regaining a level of independence and function that you’ve been lacking.

The surgeon writes you a prescription for a new prosthesis, and hands it to you. He or she also gives you a sheet of paper contain-ing the names and addresses of several local prosthetists. The surgeon circles one of the names and says, “I’ve seen patients have excellent results with this group in particular. You can obviously go to any of the individu-als on this list, but this is the one I’mmost familiar with.” What the surgeon doesn’t say is that he or she owns the prosthetic facility, and is the boss of the prosthetist employed by the surgeon’s company to run it.

Is this legal? Can a physician refer you to a prosthetic facility that he or she owns, either in whole or in part? To understand the answer to these questions, you frst need to know about the Stark Law, which was created to address exactly these kinds of situations.

This article addresses the following issues: (1) What does the Stark Law prohibit and what does it permit? and (2) How does it potentially affect your prosthetic care and treatment?

The Stark Law&Prosthetics

The Stark Law prohibits doctors from refer-ring Medicare and Medicaid benefciaries to an entity in which they or an immediate family member have an ownership interest. The statute’s purpose is simple: to prevent doctors from overprescribing certain types of treatment based on their equity in another healthcare business.

The statute lists 10 different kinds of “desig-nated health services,” including prosthetics, which are subject to the prohibition. Impor-tantly, however, if the designated health service fts within one of the many – 21, to be exact – exceptions built into the law, then the physician can deliver those items to patients in a facility he or she owns without violating Stark.

by David McGill

imagine, for a second, that the vascular sur-geon who performed your amputation also owns a prosthetic facility. You go to the surgeon’s offce for a follow-up visit a week or two after your sur-gery and he or she tells you that your limb has healed enough to start the prosthetic ftting and delivery process.

The Stark Law:

WhatAmputees Need to Know

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