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The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity.
Several healthcare providers have violated the Anti-Kickback Statute by offering investment interests, excessive compensation, or space and equipment deals to physicians that is designed to encourage the physician to refer patients or utilize a specific facility or healthcare services. Mergers and acquisitions.
The Federal Anti-Kickback Statute is a criminal statute and the penalties for violations of the law can be severe. They include fines of up to $25,000 per violation, felony conviction punishable by imprisonment up to five years, or both, as well as possible exclusion from participation in Federal Healthcare Programs.
- Bona Fide Employment Relationship. …
- Personal Service Arrangements. …
- Lease or Rental of Office Space or Equipment. …
- Referral Services. …
- Group Purchasing Organizations.
The Anti-Kickback Statute and Stark Law prohibit medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients who will receive treatment paid for by government healthcare programs such as Medicare and Medicaid, and from entering into certain kinds of …
The Anti-Kickback Law covers referrals for all services from anyone including physicians or pharmaceutical companies. Conversely, the Stark Law is for referrals from physicians only and covers a set list of “Designated Health Services” (DHS).
- Gifts. Any gift of above nominal value, including things such as food, event tickets, and gift cards, is an improper kickback. …
- Bribes. …
- Over Billing. …
- Diverting business to vendors. …
- Using payments or compensation to refer patient.
A kickback is an illegal payment intended as compensation for preferential treatment or any other type of improper services received. The kickback may be money, a gift, credit, or anything of value.
It’s simple to define what kickbacks in health care are. If a physician or medical provider uses any payment or compensation to encourage a patient to come to their office, or to encourage another medical provider to refer patients to their office or facility, that is a kickback.
At its heart, it is an anti-corruption statute designed to protect federal health care program beneficiaries from the influence of money on referral decisions and thus is intended to guard against overutilization, increased costs, and poor quality services.
What does the Anti-Kickback Statute Prevent? Prohibits offering, paying, soliciting, or receiving anything of value in induce or reward referrals or generate Federal health care program business.
The False Claims Act, 31 U.S.C. §§ 3729, provides that anyone who violates the law “is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000, . . . plus 3 times the amount of damages.” But how does that apply in practice?
Examples of prohibited kickbacks include receiving financial incentives for referrals, free or very low rent for office space, or excessive compensation for medical directorships.
The safe harbor regulations define payment and business practices that will not be considered kickbacks, bribes, or rebates that unlawfully induce payment by Medicare or Medicaid programs. The regulations specify allowable financial and referral relationships between physicians or other providers and suppliers.
- Be aware of several safe harbors to the federal anti-kickback statute. …
- Educate yourself about the risks. …
- Ask yourself whether certain gifts are legitimate. …
- Develop standards and procedures to address arrangements with other healthcare providers and suppliers.
A “kickback” is a term used to refer to a misappropriation of funds that enriches a person of power or influence who uses the power or influence to make a different individual, organization, or company richer. Often, kickbacks result from a corrupt bidding scheme. … Some also consider kickbacks to be a type of bribery.
Federal and state laws prohibit the payment of kickbacks in commercial transactions. Pharmaceutical kickbacks drive up costs for consumers and corrupt professional advice. Kickback schemes also create an uneven playing field that disadvantages those honest businesses that seek to comply with the law.
Most of your healthcare providers do not earn any profits based on your medical testing. Kickbacks or commissions, where a laboratory or facility pays a healthcare provider for referrals, are illegal in most states in the United States, although there are certainly examples of fraud.
Intent Required The AKS requires proof of actual unlawful intent. The Stark Law is a strict liability statute – no intent is required to be shown.
Stark Laws and Anti-Kickback Statutes Do Not Apply to Private Insurance. The Anti-Kickback Statute and Stark laws do not apply to physicians who are not offering services covered by some government programs, such as Medicare or Medicaid.
The OIG protocols are generally used where there is a potential violation of the Anti-kickback Statute, overpayments that become False Claims under the 60-day repayment rule, and other cases where CMP statutes are potentially implicated. It is not always clear whether a violation of a CMP law has occurred.
- Vendor ownership and valid employee identification number.
- Physical address and valid phone numbers.
- Website presence.
Detection of Bribery and Kickback Schemes Compare prices paid for goods and services to market rates. Analyze purchase levels by vendor. Analyze inventory overstocks and shortages. Identify continued purchases of inferior-quality goods.
Most bribes in exchange for large contract awards in international development projects are paid as kickbacks, usually totaling 5%-20% of the contract value.
A kickback is a crime that is similar to a bribe. It involves corruption, however, kickbacks differ from bribes, because they typically involve a pre-negotiated trade of goods and/or services and a quid pro quo style of cooperation.
Bribes and kickbacks can be managed ethically within the framework constructed for gifts. Both bribes and kickbacks function as gifts that do, in fact, corrupt an employee’s professional judgment.
In 1974, the Real Estate Settlement Procedures Act (RESPA) was created to stop kickbacks between service companies and real estate agents. This regulation made kickbacks illegal. This is because real estate agents were not putting the best interest of their clients ahead of their financial gains.
Federal laws prohibit kickbacks and improper compensation to doctors and other healthcare providers as specified by the Stark Law because those financial incentives often result in medically unnecessary treatment and the use of more expensive products.
The Physician Self-Referral Law, commonly known as the Stark Law, and the Anti-Kickback Statutes are two federal laws that protect whistleblowers and prohibit a wide range of conduct by healthcare providers.
Upcoding is illegal, but there are hospitals and healthcare providers who have been caught doing it. 4 Administrators who run healthcare systems can benefit professionally when their profits are impressive, and upcoding is one way to make that happen by cheating the system.
Waste includes practices that, directly or indirectly, result in unnecessary costs to the Medicare Program, such as overusing services. Waste is generally not considered to be caused by criminally negligent actions but rather by the misuse of resources.
Examples of practices that may violate the False Claims Act if done knowingly and intentionally, include the following: Billing for services not rendered. Knowingly submitting inaccurate claims for services. Taking or giving a kickback for a referral.
Under the False Claims Act, the Department of Justice is authorized to pay rewards to those who report fraud against the federal government and are not convicted of a crime related to the fraud, in an amount of between 15 and 25 (but up to 30 percent in some cases) of what it recovers based upon the whistleblower’s …
Kennedy Vuernick Helps Whistleblowers Pursue False Claims Act Recoveries. Fraud against the government, like any fraud, is just theft by another name. The ultimate victim is not the government: it is the hardworking taxpayer. Government funds come from taxpayers, and so theft from the government is theft from taxpayers …
Several healthcare providers have violated the Anti-Kickback Statute by offering investment interests, excessive compensation, or space and equipment deals to physicians that is designed to encourage the physician to refer patients or utilize a specific facility or healthcare services. Mergers and acquisitions.
Enactment and Expansion of the Federal Anti-Kickback Statute In an effort to ensure that only necessary items and services were being provided to Medicare and Medicaid beneficiaries, Congress passed the AKS in 1972, as an amendment to the Social Security Act.
The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity.