The United States Centers for Medicare and Medicaid Services (CMS) recently released data regarding 2023 settlements of voluntary self-disclosures related to past or potential violations of the physician self-referral law (the Stark Law). According to the data, CMS settled an agency record of 176 self-disclosures, totaling more than $12,000,000.
Under the Stark Law, physicians are prohibited from making a referral for designated health services (including clinical laboratory services, radiology and certain other imaging services, and durable medical equipment and supplies) payable by Medicare to an entity with which the physician – or an immediate family member of the physician – has a financial relationship, unless an exception applies. Under the CMS voluntary self-referral disclosure protocol (SRDP), healthcare providers and suppliers can self-disclose actual or potential violations of the Stark Law to resolve overpayment liability for the disclosed conduct.
As noted above, 2023 was a record year for Stark Law settlements, but the average settlement amount has not changed materially from year to year. The average settlement for 2023 was $71,363.73, the average for 2022 was $90,173.46, and the average for 2021 was $73,646.33. Settlement percentages and amounts vary depending on certain factors involved in each case, and the average can be skewed if there are several high or low outliers in the settlement amounts, so we can’t easily draw conclusions from that dataset without additional information.
The range of settlements in 2023 is interesting, though, with the lowest ever reported SRDP settlement ($26 – prior lowest settlement was $33 in 2020) and the smallest maximum settlement in a year since the smallest maximum settlement amount was recorded in 2019 ($548,302, compared to $280,068 in 2019).
CMS also noted that as of December 31, 2023, 267 disclosures to the SRDP were withdrawn, closed without settlement, or settled by CMS’ law enforcement partners.
The record number of settlements, continuing from 2022, show the focus of CMS on working through SRDP submissions in a more efficient manner than in the past. For individuals who are considering the SRDP process, the 2023 reported settlements indicate that a settlement may come sooner than anticipated.