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Anti-Kickback Statute and Stark Law Violations
The federal Anti-Kickback Statute and Stark Law operate to prevent medical providers from making health care decisions based on personal financial incentives rather than the best interests of the patient. When Medicare, Medicaid, and other government health care programs foot the bill for medical services or procedures induced by illegal financial arrangements, this is fraud that is subject to liability under the False Claims Act. Such fraudulent schemes are rampant in the health care system and are frequently complex and difficult to detect. Qui tam relators are critical to the discovery and eradication of such schemes.
The federal Anti-Kickback Statute (AKS) makes it unlawful for anyone—including doctors, hospitals, ambulatory surgical centers, laboratories, practice-management companies, health care corporations, and others—to pay kickbacks to health care providers in exchange for the referral of business payable by Medicare, Medicaid, or other federal health care programs. Kickbacks can be anything of value, such as gifts or free perks, not just the payment of cash. End-of-year rebates and volume-based rebates are types of kickbacks. Both the people who offer or provide kickbacks and the medical providers who solicit or accept those kickbacks may be subject to criminal penalties.
The federal Stark Law targets physician self-referrals by prohibiting doctors from referring Medicare or Medicaid patients to entities in which the doctor or his or her immediate family has a personal financial interest.
Murphy Anderson lawyers have a nuanced understanding of the intricacies of the AKS and Stark Law, as well as the exceptions to those laws. Our lawyers are familiar with the AKS “safe harbors”—the specifically enumerated financial and business arrangements that are legal notwithstanding the AKS. Our attorneys are adept at assessing whether financial arrangements that appear legitimate are in fact unlawful under the AKS or Stark Law and whether or not a safe harbor applies. Our lawyers remain current on guidance from the Department of Health and Human Services (HHS) and the HHS Office of Inspector General (OIG) to keep abreast of those issues that are of priority to the government.
Our cases have involved a wide range of kickback schemes and unlawful business arrangements. Examples include: health care companies’ provision of medical and office supplies in exchange for referral of Medicare and Medicaid patients; “swapping arrangements” whereby health care entities offer discounts to medical providers’ private pay patients to induce Medicare and Medicaid referrals; a joint venture between a practice management company and physician investors to operate an ambulatory surgical center in which the company required physician investors to refer a minimum quota of patients under penalty of divestment; and many others.