Healthcare Anti-Kickback Violations
WHAT IS THE ANTI-KICKBACK STATUTE?
The federal Anti-Kickback Statute (AKS) (See 42 U.S.C. § 1320a-7b.) is a criminal law that prohibits people from exchanging things of value, in order to get referrals of business that will be paid for by federal health care programs. Major federal healthcare programs include Medicare, Medicaid, and the Veteran’s Health Administration. Anti-kickback includes receiving financial incentives for referrals, free or excessively cheap rent for office space, or excessive compensation for medical directorships. Another example of a kickback includes waiving copayments. According to the Center for Medicare and Medicaid Services, illegal kickbacks have resulted in higher medical costs, overutilization of medical services, and corruption of medical decision-making. Anti-kickback laws are intended to protect the public from medical decisions that are made based on money instead of health reasons. If you are facing an alleged violation of anti-kickback laws, then it is important to speak to an experienced healthcare fraud attorney as soon as possible.
WHAT ARE THE CONSEQUENCES OF ANTI-KICKBACK VIOLATIONS?
If you are alleged to have violated federal anti-kickback laws, then you face the potential of both a criminal and civil claim. If you are criminally charged, then you face the potential of up to five years in federal prison, along with fines of up to $50,000 per offense. Further, a conviction will result in you being excluded from doing any future business with a federal health care program. The Office of Inspector General is required by law under the Exclusion Statute (See 42 USC § 1320a-7) to exclude anyone convicted of specific health care fraud crimes from doing any future participation in any federal health care programs. Federal anti-kickback laws apply to any referral source, the referral does not have to come from a physician for a criminal charge to be filed. A referral under the anti-kickback law is “any item or service for which payment may be made in whole or in part under a federal health care program.” This means that anyone who is shown to purposely send a medical provider clients with the expectation of payment that involves a federal healthcare program can result in federal anti-kick back criminal charges.
HOW CAN ANTI-KICKBACK APPLY TO HEALTHCARE FRAUD CASES?
If it can be shown that there was a willful payment to someone to induce or reward medical patient referrals involving a federal healthcare program, then anti-kickback charges can be part of a larger federal healthcare fraud case. In other industries, referral fees are permitted and even encouraged. In federal health care, paid referrals are against the law. Other related healthcare fraud activities include billing for services not rendered, administering medically unnecessary treatment, and falsifying diagnoses. Violations of the federal anti-kickback statute can result in a civil claim under the False Claims Act (See 31 USC §§ 3729-3733). The False Claims Act is a law that protects the federal government from being falsely billed or sold inferior goods or services. The civil penalty for a False Claims Act violation can be up to three times the value of the loss suffered by the federal government plus $11,000 per claim filed. A violation does not require actual knowledge, and an individual can be convicted for deliberate ignorance or having a total disregard for the truth of relevant information. Another related federal healthcare fraud statute is the Physician Self-Referral law (See 42 USC § 1395nn). This law, also known as the Stark Law, outlaws physicians from referring patients to medical providers with whom the physician or an immediate family has a financial relationship. This only applies to designated health services that are payable by Medicare or Medicaid. There are exceptions that exist to allow self-referrals.
HOW DOES THIS AFFECT ME?
Hopefully, none of this affects you. But if you are currently being investigated for an alleged anti-kickback violation, or have already been charged, then this can affect you directly. Investigation and enforcement related to different variations of healthcare fraud are a high priority for federal prosecutors across the country. If you need legal help, then be sure to speak to an experienced attorney right away.
FREE AND CONFIDENTIAL CONSULTATION
At Bajoka Law we are proud to offer consultations that are both FREE and CONFIDENTIAL. We realize that anti-kickback cases require the proper discretion, and we will treat your situation with the utmost care and caution. It’s time you started to retake control of your life. Feel free to contact us anytime at 1-844-4BAJOKA (1-844-422-5652). You can also contact us online
here. We have three statewide offices to service you in Detroit, Lansing, and Warren MI. Your freedom could be a phone call away, but it is up to you to make that call. Our attorneys at Bajoka Law are available now to take your call and your case.
