On March 30, 2012, finding that the district court violated Tuomey’s Seventh Amendment right to a jury trial, the United States Court of Appeals for the Fourth Circuit vacated a $44.9 million judgment against Tuomey Healthcare System, Inc. (Tuomey) for Stark law violations and remanded the case to federal district court. (United States ex rel. Drakeford v. Tuomey Healthcare System Inc., 4th Cir., No. 10-1819, March 30, 2012). While the Fourth Circuit’s opinion largely addresses procedural issues, two judges on the three-judge panel took the opportunity to outline their views on certain Stark law issues raised in the Tuomey case. Specifically, the judges addressed the following two questions:

(1) Whether the facility component of hospital outpatient services performed by the physicians pursuant to certain contracts (described below), for which Tuomey billed a facility fee to Medicare, constituted a “referral” within the meaning of the Stark law and Stark regulations (Issue No. 1); and

(2) Whether, assuming that Tuomey considered the volume or value of anticipated facility component referrals in computing the physicians’ compensation, the contracts implicated the “volume or value” standard under the Stark law (Issue No. 2).