Stark Law Reform

Over the last several years, there have been attempts to curb the ability of independent physician practices to offer clinically appropriate ancillary services to their patients. These attempts have focused on curbing or eliminating the In-Office Ancillary Services Exception (IOASE), which permits physicians who are members of a group practice to refer a patient for designated health services (DHS) without violating the Stark Law.


In the more than 25 years since its passage, the law has become one of the most significant sources of regulatory burden on physicians and, ultimately, for Medicare beneficiaries. These restrictions make it more difficult for independent physician practices to coordinate care, creating a competitive advantage for large hospital systems.

Given that the system is rapidly transitioning away from fee-for-service payment, the law is outdated.


Modernization of the Stark Law would empower physician practices to engage in value-based care, allowing them to take on risks and improve clinical outcomes through Alternative Payment Models (APMs). LUGPA supports enactment of legislation that would permit independent practices to test and participate in APMs without the current prohibitions.

In addition, LUGPA will continue to defend the In-Office Ancillary Service Exemption, which allows the integrated delivery of care by physician practices under the fee-for service system, including for radiation therapy, labs and advanced imaging by physician practices.


LUGPA Policy Brief: Enhancing Provider Safety - Nov. 2023 

LUGPA Policy Brief: Seniors' Access to Critical Medications Act  - October 2023

LUGPA Policy Brief: Value-Based Care Models - June 2023 

In-Office Dispensing Policy Brief - May 2023

Stark Law update - April 2023

HHS issues significant changes to Stark and Anti-Kickback Statute - Nov. 21, 2020

Regulators delay final updates to self-referral law - August 27, 2020

Comment letter to the Department of Health and Human Services regarding the Anti-Kickback Statute Proposed Rule - December 31, 2019

Comment letter to the Centers for Medicare & Medicaid Services regarding the Stark Proposed Rule - December 31, 2019

Proposed Rule: Medicare Program; Modernizing and Clarifying the Physician Self-Referral Regulations - October 17, 2019

Fact Sheet: Modernizing and Clarifying the Physician Self-Referral Regulations Proposed Rule - October 9, 2019

LUGPA Comments to OIG on Request for Information Regarding the Anti-Kickback Statute and Beneficiary Inducements Civil Monetary Penalty – October 26, 2018

LUGPA Comments to Medicare Program Request for Information on Stark Law Modernization – August 24, 2018

Changes Needed to Stark Law, House Members Told – July 18, 2018

LUGPA to Testify at Stark Law Hearing in Support of Modernization – July 17, 2018

              Testimony of Dr. Gary Kirsh (transcript)

Update the Stark law now, HHS and providers tell Congress – July 17, 2018

Dr. Neal Shore: Independent practices may not be viable if CMS doesn’t act – July 17, 2018

Supporting the Independent Practice in a Value-Based Care System – July 16, 2018

Congressional action on Stark Law is critical to developing value-based healthcare – June 27, 2018

LUGPA Supports CMS’ Efforts to Modernize Stark Law – June 20, 2018

LUGPA Comments to Congress Re: Modernizing Stark Law – January 29, 2016

GAO’s Draft Report on the Impact of Self-Referral on Radiation Oncology Services – June 18, 2013