Choosing the right healthcare provider for your family is one of the most important decisions you’ll ever make. From lab tests to physical therapy and home health care, families often need a variety of medical services throughout their lives. But not all services are created equal—especially when it comes to Designated Health Service (DHS).
In this blog, we’ll explore what designated health services are, why they matter for families, and how to choose the right ones to ensure quality, compliance, and peace of mind.
What Is a Designated Health Service?
A Designated Health Service (DHS) is a term used by the Centers for Medicare & Medicaid Services (CMS) to describe certain types of healthcare services that are heavily regulated under the Stark Law—a federal law designed to prevent physicians from making referrals based on financial gain.
In simple terms, DHS includes a list of services that doctors are not allowed to refer patients to if they or their family members have a financial interest in the facility, unless they meet specific legal exceptions.
Common Types of Designated Health Services
Families are most likely to encounter the following DHS categories:
- Clinical laboratory services (e.g., blood tests)
- Imaging and radiology (e.g., X-rays, MRIs)
- Physical and occupational therapy
- Durable medical equipment (e.g., crutches, wheelchairs)
- Home health services
- Outpatient prescription drugs
- Inpatient and outpatient hospital services
Knowing which services fall under this category helps you make informed choices about where and how your family receives care.
Why Choosing the Right DHS Provider Matters for Families
When you’re looking for care for your children, spouse, or aging parents, your goal is simple: find trustworthy professionals who provide safe, effective treatment. Choosing the right DHS provider ensures:
✅ Compliance with federal law
✅ Protection from unnecessary or costly referrals
✅ High-quality, ethical medical services
✅ Proper insurance coverage, especially for Medicare or Medicaid
Step-by-Step Guide to Choosing the Right Designated Health Service
1. Start by Understanding Your Family’s Needs
Every family is different. Are you caring for a child with a developmental condition? Is a loved one recovering from surgery or managing a chronic illness? Identifying your needs helps narrow your search.
Make a list of services your family needs now—or might need in the near future. This could include:
- Pediatric imaging
- Physical therapy for injury recovery
- Home nursing for an elderly parent
- Regular lab tests for chronic conditions
2. Ensure the Provider is DHS-Compliant
Ask the provider directly:
“Do you comply with Stark Law regulations regarding designated health services?”
A reputable provider will be transparent about their referral practices and any financial interests they may have. If they own the lab or physical therapy clinic they’re referring you to, they should disclose this and explain whether a legal exception applies.
3. Verify Credentials and Licensing
Choose providers that are licensed by state health authorities, certified by Medicare or Medicaid, and accredited by national organizations. For example:
- Look for JCAHO (Joint Commission) accreditation
- Confirm licensure with your state health department
- Check for certifications in specialties like radiology or physical therapy
4. Check Insurance Coverage and Out-of-Pocket Costs
Ask these essential questions:
- Do you accept my family’s insurance?
- Is this service covered under Medicare or Medicaid?
- What will my out-of-pocket costs be?
This is especially important for services like durable medical equipment or lab work, where billing can vary widely between providers.
5. Compare Quality Ratings and Patient Reviews
You can evaluate DHS providers using:
- Medicare’s Care Compare Tool: See facility ratings and inspection reports.
- Google or Yelp reviews: Read real patient experiences.
- State-run health databases: Check for complaints or violations.
Look for facilities with consistently high ratings, clean environments, and courteous staff.
6. Ask About Communication and Support
The best providers will take the time to explain procedures, involve you in the decision-making process, and provide written instructions for care and billing.
You should feel comfortable asking:
- What are my treatment options?
- How will my family be involved in the care plan?
- Who do I call with follow-up questions?
7. Avoid Red Flags
Be cautious of providers who:
- Won’t explain billing or insurance coverage
- Automatically refer you to in-house services without explanation
- Pressure you into unnecessary tests or equipment
- Fail to disclose ownership or financial interests in other services
These could be signs of non-compliant or unethical practices.
The Role of the Stark Law in Family Health Decisions
The Stark Law exists to protect patients from self-referral abuse. This matters for families because:
- It ensures referrals are based on medical necessity—not financial incentives.
- It increases transparency in the healthcare system.
- It helps you avoid being overcharged for unnecessary services.
By choosing DHS providers who follow these rules, you’re making safer choices for your family.
How to Find Reputable DHS Providers
Use the following tools and strategies:
- Ask your primary care doctor for referrals and ask if there’s any financial relationship involved.
- Search online directories like Medicare.gov or your insurance provider’s network.
- Visit or call the facility to ask about licenses, services, and patient care practices.
- Check compliance by searching for any history of legal violations or complaints.
Frequently Asked Questions (FAQs)
Q1: What’s the difference between a regular health service and a designated health service?
A designated health service (DHS) is regulated by federal law because it’s more prone to conflicts of interest. Regular health services may not fall under the same level of scrutiny.
Q2: Is it illegal for my doctor to refer me to a facility they own?
Not necessarily. It depends on whether the referral falls under an exception to the Stark Law. However, they must disclose the financial interest and ensure the arrangement meets federal guidelines.
Q3: How do I know if a provider is DHS-compliant?
Ask directly. Reputable providers will explain their policies and any relationships they have with other service providers.
Q4: Do all insurance plans cover DHS services?
Most designated health services are covered by Medicare, Medicaid, and private insurance, but coverage can vary by provider and plan. Always verify in advance.
Q5: What should I do if I suspect a violation of the Stark Law?
You can report your concerns to:
- The Office of Inspector General (OIG)
- The Centers for Medicare & Medicaid Services (CMS)
- Your state health department
Final Thoughts
Choosing the right Designated Health Service for your family involves more than convenience. It’s about trust, quality, transparency, and compliance with healthcare laws that protect you.
By following this guide, you’ll be better equipped to:
- Make informed choices
- Avoid unethical or unnecessary care
- Get the best possible services for your family’s well-being
Whether you need a simple blood test or long-term therapy, always ask questions, verify credentials, and choose providers who put your family’s health first.
