HEC Forum

, Volume 18, Issue 1, pp 61–84 | Cite as

Stark Regulation: A Historical and Current Review of the Self-Referral Laws

  • Morey J. Kolber


Current Review 
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  1. American Association of Orthopaedic Surgeons website. (2004). The state of Stark: Phase II regs. [On-line] Available: (Accessed November 18, 2004).
  2. American Association of Orthopaedic Surgeons (AAOS) (2004). AMA House of Delegates supports AAOS on radiology issue. [On-line] Available: (Accessed November 16, 2004).
  3. American Academy of Orthopaedic Surgeons (AAOS) (1995). Statement of the American Academy of Orthopaedic Surgeons on physician self-referral before the House Ways and Means Subcommittee on Health. [On-line] Available: (Accessed October 9, 2004).
  4. The American College of Physicians (ACP). (2004). Ethics manual 4th ed. [On-line] Available: (Accessed November 18, 2004).
  5. American Physical Therapy Association (APTA) web page. (2004). Government Affairs. [On-line] Available: (Accessed November 18, 2004).
  6. Angell, D.E. (1982). HB 4867: The laboratory referrals bill. Michigan Medicine. 81, 28–29.Google Scholar
  7. AORN 50th Congress. (2003). Kickbacks and unlawful referrals. Session 7029. [On-line] Available: (Accessed November 18, 2004).
  8. Centers for Medicare and Medicaid Services. (2004). Federal Register. Phase two correction. [On-line] Available: (Accessed October 10, 2004).
  9. Centers for Medicare and Medicaid Services. (2004). Physicians Self Referral Educational Resource Web Guide. [On-line] Available: (Accessed November 17, 2004).
  10. Congressman Pete Stark's Statement. (2000). Department of justice has more than 50 ongoing physician referral anti-fraud cases underway. [On-line] Available: (Accessed November 10, 2004).
  11. Congressman Pete Stark's Statement. (1999). Introduction of the Medicare Physician Self-Referral Improvement Act of 1999. [On-line] Available: (Accessed November 19, 2004).
  12. Congressman Pete Stark's Statement. (2000). Letter on the recent regulations on Stark II/The physician self-referral laws. [On-line] Available: (Accessed October 10, 2004).
  13. Dean, R.S. (1995). Survival of physician self-referral to physical therapy centers with physician-held owner interest. College Review, 12,(1):27–62.Google Scholar
  14. Federal Register. (2004). Department of Health and Human Services. 42 CFR parts 411 and 424. [On-line] Available: (Accessed November 18, 2004).
  15. Dechene, J.C., O'Neil, K.P. (1996). “Stark II” and state self-referral restrictions. Journal of Health and Hospital Law, 29, 65–87.Google Scholar
  16. Department of health and Human Services. (1999). Federal Register. [On-line] Available: (Accessed November 18, 2004).
  17. DHHS, Office of Inspector General, Office of Evaluation and Inspections report. (1994). OEI-02–90-00590.Physical therapy in physicians offices. [On-line] Available: (Accessed November 16, 2004).
  18. Find Law For Corporate Counsel. (2004). Physical therapists applaud new Medicare rule setting standards for therapy care in physicians offices. [On-line] Available: (Accessed November 17, 2004).
  19. Find Law For Legal Professionals. (2004). Title 42 š The public health and welfare, section 1395nn. [On-line] Available: (Accessed November 18, 2004).
  20. Find Law For Legal Professionals. (2004). Physical therapy services š Criteria strict for physician clinics. [On-line] Available: (Accessed November 16, 2004).
  21. Fitzgerald, P.D. (2001). The ethics of doctors and big business. The Medical Journal of Australia, 175, 73–75.Google Scholar
  22. Flanagan, M.E., Thiel, D.K. (1990). Stark reality. Health Progress, 71, 70–77.Google Scholar
  23. Gamble, VN. (1989). H.R. 5198: The ethics in patient referrals act: implications for providers. The Journal of Ambulatory Care Management, 12, 83–86.Google Scholar
  24. GAO Report No. B-253835 (1994). Medicare: Referrals to Physician-Owned Imaging Facilities Warrant HCFA's Scrutiny. Washington D.C.: GOA.Google Scholar
  25. Gosfield, A.G. (2004). Ten myths about the stark statute debunked. The Journal of Medical Practice Management, 19, 200–203.Google Scholar
  26. Guglielmo, W.J. (2004). A physicians guide to stark rules. [On-line.] Available: 81, 23–26.
  27. Hemenway, D., Killen, A., Cashman, S.B., Parks, C.L., Bicknell, W.J. (1990). Physicians' responses to financial incentives. Evidence from a for-profit ambulatory care center. The New England Journal of Medicine, 322, 1059–1063.Google Scholar
  28. Hillman, B.J., Joseph, C.A., Mabry, M.R., Sunshine, J.H., Kennedy, S.D., Noether, M. (1990). Frequency and costs of diagnostic imaging in office practice š a comparison of self–referring and radiologist-referring physicians. The New England Journal of Medicine, 323, 1604–1608.Google Scholar
  29. Hillman, B.J., Olson, G.T., Griffith, P.E., et al. (1992). Physicians utilization and charges for outpatient diagnostic imaging in a Medicare population. The Journal of the American Medical Association, 268, 2050–2054.CrossRefGoogle Scholar
  30. Joint Ventures Among Health Care Providers in Florida (1991). State of Florida cost containments board.Google Scholar
  31. Lindeke, J.M., Solomon, J.E. (1989). The ethics in patient referrals act of 1989: an analysis of the bill and the issue. The Medical Staff Counselor, 3, 1–7.Google Scholar
  32. Longest, B.B.Jr. (2002). Health policymaking in the United States. 3rd ed. Chicago, Illinois: Health Administration Press.Google Scholar
  33. Margolis, R.E. (1993). Physician self-referrals: Stark pushing total ban on physician ownership and self-referral deals. HealthSpan, 10, 14–16.Google Scholar
  34. Mitchell, J.M., Scott, E. (1992a). Physician ownership of physical therapy services. Effects on charges, utilization, profits, and service characteristics. The Journal of the American Medical Association, 268, 2055–2059.Google Scholar
  35. Mitchell, J.M., Scott, E. (1992b). New evidence of the prevalence and scope of physician joint ventures. The Journal of the American Medical Association, 268, 80–84.Google Scholar
  36. Mitchell, J.M., Sunshine, J.H. (1992). Consequences of physician ownership of health care facilities š joint ventures radiation therapy. The New England Journal of Medicine, 327, 1497–1501.Google Scholar
  37. Morse, R.A., Popovits, R.M. (1989). Stark's crusade: the ethics in patient referrals act of 1989. Journal of Health and Hospital Law, 22, 208–224.Google Scholar
  38. Office of Inspector General (OIG) Report. (1989). Financial arrangements between physicians and health care businesses. OAI-12–01410.Google Scholar
  39. Physicians New Digest. (1996). Satisfying Stark 2 group practice regs. [On-line] Available: (Accessed November 16, 2004).
  40. Relman, A.S. (1985). Dealing with conflicts of interests. The New England Journal of Medicine, 313, 749–751.Google Scholar
  41. Rosenfeld, R.H. (1984). Market forces set off skyrocketing interesting hospital-doctor joint ventures. Modern Healthcare, 14, 60–64.Google Scholar
  42. Siegal, S. (2004). A review of the new stark phase II regulations. Health Care Law Monthly, 3–15.Google Scholar
  43. The Social Security Administration web page. (1993). P.L. 103-66, Approved August 10, 1993 (107 Stat. 312) Omnibus Budget Reconciliation Act of 1993. [On-line] Available: (Accessed November 17, 2004).
  44. Social Security Online. (2004). Title XVIII -Health Insurance for the aged and disabled. [On-line] Available: (Accessed November 17, 2004).
  45. SPR Online. (2004). American College of Radiology. Report from The Annual Summer Conference on Intersociety Commission 2004. [On-line] Available: (Accessed April 6, 2005).
  46. Stout, S.M., Warner, D.C. (2003). How did physician ownership become a federal case? The Stark amendments and their prospects. HEC Forum, 15, 171–187.CrossRefGoogle Scholar
  47. Swartzmeyer, S., Killoran, C.N. (2004). Specialty hospital ban was premature. Modern Healthcare, 34, 21–22.Google Scholar
  48. Swedlow, A., Johnson, Q. (1999). Increased costs and rates of use in the California workers compensation system as a result of self-referral by physicians. The New England Journal of Medicine, 327, 1502–1506.Google Scholar
  49. United States Department of Health and Human Services. (2004). HHS issues final rule addressing physician self-referrals. [On-line] Available: (Accessed October 10, 2004).
  50. Wachler & Associates website. (2004). The Phase II final stark regulations are here-are you ready? [On-line] Available: (Accessed November 17, 2004).

Copyright information

© Springer Science + Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Director of Clinical ServicesPhysical Therapy Institute, Inc.Delray Beach

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