“Group Practice” Makes Perfect: What Is a “Group Practice” Under the Federal Stark Law, and How Can Physicians Comply? (Lexology)

Under the Federal Stark Law, a “group practice” is a legally defined structure allowing physicians to refer Medicare patients for designated health services (DHS) within their organization if specific criteria are met. To qualify, the group must operate as a single legal entity, consist of at least two physicians, and ensure that 75% of patient care services are furnished through the group. Billing and income must be centralized, and profit distribution or bonuses cannot directly relate to DHS referrals. Compliance strategies include forming a legal entity, centralizing finances, allocating DHS profits equitably, and implementing referral monitoring policies. Adhering to these rules is essential to avoid penalties such as Medicare claim denials, repayment obligations, or exclusion from federal programs.