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UNDERSTANDING THE ANTI-KICKBACK AND STARK LAWS

 

Illegal kickbacks and self-referral schemes play a key role in the False Claims Act (FCA). The FCA allows whistleblowers with inside information to obtain a cash award of up to 30 percent of whatever the government collects from the wrongdoer. 

 

What Is the Anti-Kickback Statute?

The Anti-Kickback Statute is a criminal law that prohibits the knowing and willful payment of "remuneration" to induce or reward patient services, referrals, or supplies payable by the federal healthcare programs. 

 

Remuneration includes anything of value and can take many forms, including:

 

  • Cash 

  • Free rent, expensive hotel stays, or costly meals 

  • Excessive compensation for medical directorships or consultancies

 

While in some industries it is acceptable to reward those who refer business to you, paying for referrals is a crime in the federal healthcare programs. As such, the Anti-Kickback Statute targets both those who offer or pay remuneration and those who solicit or receive remuneration. The parties’ intent is crucial to their liability.

 

What Is the Stark Law?

Also known as the Physician Self-Referral Law, the Stark Law prohibits physicians from referring patients to receive "designated health services"—payable by Medicare or Medicaid—from those with whom the physician or an immediate family member has a financial relationship. 

 

Financial relationships include both ownership and investment interests, and compensation arrangements. For example, if you invest in an imaging center, the Stark Law requires the corresponding financial relationship to fit within an exception. If it doesn’t fit within an exception, you may not refer patients to the facility, and the entity may not bill for the referred imaging services.

 

Designated health services include:

 

  • Clinical laboratory services

  • Physical therapy, occupational therapy, and outpatient speech-language pathology services

  • Radiology and other imaging services

  • Radiation therapy services and supplies

  • Durable medical equipment and supplies

  • Parenteral and enteral nutrients, equipment, and supplies

  • Prosthetics, orthotics, and prosthetic devices and supplies

  • Home health services

  • Outpatient prescription drugs

·       Inpatient and outpatient hospital services

 

Contact Our Attorney and Take Action Today

 

Whistleblowers are encouraged to take action, as they are entitled to a significant portion of the government's recovery under the False Claims Act. The penalties authorized under the FCA increased in 2016 to anywhere from $10,781 to $21,563 per claim. 

 

Whistleblowers should file their complaint through the U.S. Department of Justice with help from a qualified attorney. The expert attorneys at the Law Office of Sara J. Saba, P.A. are here to assist you. Please contact us online or call us directly at (305) 450-8009.

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