If you're planning on entering the CMS self-referral disclosure protocol (SRDP), be prepared to wait. I recently obtained the 10 settlement agreements that have been reached under the SRDP in 2012 through a Freedom of Information Act request, and in every agreement it took a year or more from the initial disclosure to the final settlement. One settlement, involving Flagstaff Medical Center, took almost two years to resolve, beginning with Flagstaff's disclosure of possible Stark law violations in May 2010, and ending with a $22,000 settlement in March 2012.

I spoke with attorney Laurence J. Freedman of Patton Boggs, Washington, about the settlement agreements, and he said that while the overall disclosure process seems to be working, he had concerns over the time it took to reach a resolution. Freedman said he wondered if CMS would be able to handle an increase in self-disclosures. Freedman also said CMS might want to consider creating separate tracks for disclosures, depending on the amount of money involved.

The SRDP, authorized by section 6409 of the ACA and posted on the CMS web site in September 2010, allows providers to self-disclose any potential violations of the Stark law, which prohibits physician referrals of Medicare and Medicaid patients to entities with which physicians or their immediate family members have a financial relationship.