If a medical provider either directly or indirectly refers a patient to a facility in which they have a direct economic interest it is generally a violation of the Stark Act. Penalties under Stark include recovery of payments, imposition of a $15,000 per service civil monetary penalty for knowing violations, and a monetary fine of $100,000 for each arrangement found to have willfully circumvented the statutory scheme. In an effort to prohibit medical providers from not acting in the best interest of their patients this is often enforced as a strict liability offense.
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