Wiki Provider Treating Family Members

[jenna_m]

Hello,

I am getting some mixed messages all over the places when I was researching regarding Stark law.
Here are my questions:

1. If an optometrist treats their family, are they allowed to bill insurance company for the treatment? Is it illegal under the stark law?

2. If a non-related provider within the same practice sees another provider's family member, would it be okay to bill insurance?

Thank you,
Jenna

 

[thomas7331]

Legal questions should really be addressed to an attorney in the state where your practice operates and I'm not an attorney. But I'm pretty sure that the issue of providers treating family members does not fall under the Stark Law. In my work, I have not encountered any specific laws that prohibit providers from treating family members (in fact, I think it's a pretty common practice). However, Medicare and many insurance companies will not cover a service provided to an immediate family member. There's no prohibition that I'm aware of that would prevent another provider in the same practice from seeing the patient and billing for it, and I've seen this done frequently in group practices. But again, this is something you should ask your practice's legal counsel as there could be local or state laws that need to be considered.

 

[jenna_m]

Legal questions should really be addressed to an attorney in the state where your practice operates and I'm not an attorney. But I'm pretty sure that the issue of providers treating family members does not fall under the Stark Law. In my work, I have not encountered any specific laws that prohibit providers from treating family members (in fact, I think it's a pretty common practice). However, Medicare and many insurance companies will not cover a service provided to an immediate family member. There's no prohibition that I'm aware of that would prevent another provider in the same practice from seeing the patient and billing for it, and I've seen this done frequently in group practices. But again, this is something you should ask your practice's legal counsel as there could be local or state laws that need to be considered.

Thank you so much for your answer!