Antikickback Versus Stark: A Comparison

The Centers for Medicare & Medicaid Services has begun ratcheting up enforcement in regard to billing and financial relationships. Among the laws implicated are the antikickback statute and the Stark law.

Here is a quick look at the difference between these sometime confusing laws. 



The Antikickback Statute
42 USC § 1320a-7b(b)


The Stark Law  
42 USC § 1395nn



Prohibits offering, paying, soliciting or receiving anything of value to induce or reward referrals or generate federal health care program business


Prohibits a physician from referring Medicare patients for designated health services to an entity with which the physician (or immediate family member) has a financial relationship, unless an exception applies

Prohibits the designated health services entity from submitting claims to Medicare for those services resulting from a prohibited referral



Referrals from anyone


Referrals from a physician



Any items or services


Designated health services



Intent must be proven (knowing and willful)


No intent standard for overpayment (strict liability)

Intent required for civil monetary penalties for knowing violations



  • Fines up to $25,000 per violation
  • Up to a five-year prison term per violation


  • False Claims Act liability
  • Civil monetary penalties (CMPs) and program exclusion
  • Potential $50,000 CMP per violation
  • Civil assessment of up to three times amount of kickback


  • Overpayment/refund obligation
  • False Claims Act liability
  • CMPs and program exclusion for knowing violations
  • Potential $15,000 CMP for each service
  • Civil assessment of up to three times the amount claimed



 Voluntary safe harbors


 Mandatory exceptions





Source: U.S. Health and Human Services Office of Inspector General. Visit the OIG website for additional quick-reference materials relating to health care fraud and abuse.

For more information, see these publications in the TMA Education Center:      

See also the one-hour webinar Navigating the Perilous Waters of the False Claims Act From Medical Necessity to the Anti-Kickback Statute and Beyond.


Published April 9, 2013

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