Dr. Goldberg is Director of Skin Laser & Surgery Specialists of New York and New Jersey, Director of Mohs Surgery and laser research, Mt. Sinai School of Medicine, and Adjunct Professor of Law, Fordham Law School.
The legality of pricing disparity between insured and uninsured patients is decided on a state-by-state basis. Be aware that differential billing policies can violate state consumer protection statutes.
The essence of the Stark statute is a prohibition on a physician (or immediate family member) referring a Medicare patient to an entity with which the physician or family member has a financial relationship, when the referral is for any of a targeted list of “designated health services” (DHS), unless the financial relationship meets one of a host of exceptions. For dermatology, the primary impact of this law is on relationships between dermatology practices and dermatopathologists. Because clinical laboratory services are on the DHS list, the complexities are considerable.
A doctor uses hyaluronic acid fillers on his aging patient's hands. His patient suffers complications and sues for medical malpractice, alleging that the doctor used the product for a non-FDA approved purpose.