Stark and rural offices


Fam Pract Manag. 2000 Mar;7(3):15.

To the Editor:

In your September 1999 issue, an Ask FPM question addressed Stark regulations and a potential relationship between two physicians with ultrasound equipment.

In this question, the author said he had a rural office. My understanding of the Stark regulations in the Federal Register (Jan. 9, 1998) is that if the parties are located outside of a Metropolitan Statistical Area they are exempt from Stark. Has something changed since then, or am I incorrect?


There is a rural exception in the Stark law and regulations. Specifically, section 1877(d)(2) of the Social Security Act provides that designated health services furnished by an entity in a rural area are not considered to be an ownership or investment interest otherwise prohibited under Stark if substantially all of the designated health services furnished by the entity are to individuals residing in a rural area.

Section 1886(d)(2)(D) of the Social Security Act defines the term “rural area” as any area outside a Metropolitan Statistical Area (as defined by the U.S. Office of Management and Budget). Thus, your understanding of the exception is generally correct.

It should be noted that there are other exceptions beyond the group practice exception mentioned in FPM and the rural exception mentioned above.


Copyright © 2000 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact fpmserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Sep-Oct 2020

Access the latest issue
of FPM journal

Read the Issue

FPM E-Newsletter

Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights."

Sign Up Now


Maternal Immunization Task Force for Pregnant Women: A Call to Action
The current increase in hesitancy about the safety and efficacy of vaccines has created an environment that calls for physicians’ urgent commitment to discussing the evidence-based benefits of vaccination with pregnant women.

Keys to High-Quality, Low-Cost Care: Empanelment, Attribution, and Risk Stratification
Understand attribution and alignment methodologies in value-based payment arrangements to know which patients are assigned to you. Use empanelment and risk stratification to better understand where to expend your practice's care management and care coordination resources.