Comparison Chart of Anti-Kickback Safe Harbors and Stark Exceptions -- Services Furnished by an Organization to Enrollees
Services Furnished by an Organization to Enrollees – Current as of March 2021
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Stark |
Anti-Kickback |
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The services are furnished by an organization (or its contractors or subcontractors) to enrollees of one of the following prepaid health plans (not including services provided to enrollees in any other plan or line of business offered or administered by the same organization): a) an HMO or a CMP in accordance with a contract with CMS, which set forth qualifying conditions for Medicare contracts; enrollment, entitlement, and disenrollment under Medicare contracts; Medicare contract requirements; and change of ownership and leasing of facilities: effect on Medicare contracts; b) a health care prepayment plan in accordance with an agreement with CMS; c) an organization that is receiving payments on a prepaid basis for Medicare enrollees through a demonstration project; d) a qualified HMO; e) a coordinated care plan offered by a Medicare Advantage organization in accordance with a contract with CMS; f) a managed care organization (MCO) contracting with a State Medicaid agency; g) a prepaid inpatient health plan or prepaid ambulance health plan contracting with a State; h) a health insuring organization (HIO) contracting with a State; and i) an entity operating under a demonstration project under sections 1115(a), 1915(a), 1915(b), or 1932(a) of the Act. |