What two laws primarily govern the relationships between referral sources, such as physicians and hospitals?

The relationship between referral sources, such as physicians and hospitals, is primarily governed by the Stark Law and the Anti-kickback Statute.

The Stark Law, officially known as the Physician Self-Referral Law, prohibits physicians from referring patients for certain designated health services to entities with which they have a financial relationship, unless an exception applies. This law aims to prevent conflicts of interest and ensure that medical decisions are made based on the best interests of the patient rather than financial incentives.

The Anti-kickback Statute complements the Stark Law by prohibiting the payment of any remuneration to induce or reward referrals of federal health care program business, including Medicare and Medicaid. This statute aims to protect patients and federal healthcare programs from fraud and abuse, ensuring that referrals are made based on medical necessity and the best interests of the patients, rather than financial gain.

Combining both laws, the Stark Law focuses specifically on self-referral situations, while the Anti-kickback Statute addresses broader inducements related to the referral of patients, thereby creating a regulatory framework designed to maintain ethical practices in healthcare referrals.