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Can Medical Marketers Legally Pay Patients?

March 21, 2024 Uncategorized

Why Paying Patients is Risky and May Lead to Criminal Charges

The federal government considers payments made to patients in exchange for their choice of a particular product or provider as a criminal offense. The Anti-Kickback Statute, the Beneficiary Inducement Statute, and the False Claims Act are fundamental laws that govern patient bribery cases. In this article, we will discuss why paying patients is risky and may lead to criminal charges.

Anti-Kickback Statute

The Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)) prohibits individuals or entities from knowingly or deliberately paying or receiving remuneration in exchange for referrals or the purchase of any item or service that might be paid for by a federal health insurance program. Both direct and indirect remunerations are prohibited under this statute.

Moreover, both the payer of kickbacks and the recipient of kickbacks are implicated under this law since it is reciprocal. However, there are exceptions where this statute does not apply; these include situations where beneficiaries do not participate in federal healthcare programs.

Remuneration refers to anything of value transferred directly or indirectly, overtly or covertly, in cash or kind according to OIG Advisory Opinion No. 12-21 (OIG AO 12-21). It can encompass more than just cash but also gifts such as gift cards, waiver fees, complimentary equipment prizes etc.

Inappropriate remuneration occurs when it persuades patients into choosing specific providers’ prescriptions medical services through inappropriate means like giving them gift cards so they would provide their Medicare details which were then used to bill lab testing fraudulently establishing fictitious medical studies as a shroud for disbursing payments coaxing them into employing certain providers.

Penalties: A breach of the Anti-Kickback statute is considered a felony offense punishable with up to five years jail time fines amounting up $25,000 for each infraction and compulsory exclusion from federal healthcare programs. Any violation of the Anti-Kickback Statute is automatically considered a violation of the False Claims Act.

Christine Twomey
Christine Twomey
2024-03-21
Just had my Divorce case settled 2 months ago after having a horrible experience with another firm. I couldn’t be happier with Claire Banks and Elizabeth Garvey with their outstanding professionalism in doing so with Spodek Law Group. Any time I needed questions answered they were always prompt in doing so with all my uncertainties after 30 yrs of marriage.I feel from the bottom of my heart you will NOT be disappointed with either one. Thanks a million.
Brendan huisman
Brendan huisman
2024-03-18
Alex Zhik contacted me almost immediately when I reached out to Spodek for a consultation and was able to effectively communicate the path forward/consequences of my legal issue. I immediately agreed to hire Alex for his services and did not regret my choice. He was able to cover my case in court (with 1 day notice) and not only was he able to push my case down, he carefully negotiated a dismissal of the charge altogether. I highly recommend Spodek, and more specifically, Alex Zhik for all of your legal issues. Thanks guys!
Guerline Menard
Guerline Menard
2024-03-18
Thanks again Spodek law firm, particularly Esq Claire Banks who stood right there with us up to the finish line. Attached photos taken right outside of the court building and the smile on our faces represented victory, a breath of fresh air and satisfaction. We are very happy that this is over and we can move on with our lives. Thanks Spodek law 🙏🏼🙏🏼🙏🏼🙏🏼🙌🏼❤️
Keisha Parris
Keisha Parris
2024-03-15
Believe every single review here about Alex Z!! From our initial consultation, it was evident that Alex possessed a profound understanding of criminal law and a fierce dedication to his clients rights. Throughout the entirety of my case, Alex exhibited unparalleled professionalism and unwavering commitment. What sets Alex apart is not only his legal expertise but also his genuine compassion for his clients. He took the time to thoroughly explain my case, alleviating any concerns I had along the way. His exact words were “I’m not worried about it”. His unwavering support and guidance were invaluable throughout the entire process. I am immensely grateful for Alex's exceptional legal representation and wholeheartedly recommend his services to anyone in need of a skilled criminal defense attorney. Alex Z is not just a lawyer; he is a beacon of hope for those navigating the complexities of the legal system. If you find yourself in need of a dedicated and competent legal advocate, look no further than Alex Z.
Taïko Beauty
Taïko Beauty
2024-03-15
I don’t know where to start, I can write a novel about this firm, but one thing I will say is that having my best interest was their main priority since the beginning of my case which was back in Winter 2019. Miss Claire Banks, one of the best Attorneys in the firm represented me very well and was very professional, respectful, and truthful. Not once did she leave me in the dark, in fact she presented all options and routes that could possibly be considered for my case and she reinsured me that no matter what I decided to do, her and the team will have my back and that’s exactly what happened. Not only will I be liberated from this case, also, I will enjoy my freedom and continue to be a mother to my first born son and will have no restrictions with accomplishing my goals in life. Now that’s what I call victory!! I thank the Lord, My mother, Claire, and the Spodek team for standing by me and fighting with me. Words can’t describe how grateful I am to have the opportunity to work with this team. I’m very satisfied, very pleased with their performance, their hard work, and their diligence. Thank you team!
Anthony Williams
Anthony Williams
2024-03-12
Hey, how you guys doing? Good afternoon my name is Anthony Williams I just want to give a great shout out to the team of. Spodek law group. It is such a honor to use them and to use their assistance through this whole case from start to finish. They did everything that they said they was gonna do and if it ever comes down to it, if I ever have to use them again, hands-down they will be the first law office at the top of my list, thank you guys so much. It was a pleasure having you guys by my side so if you guys ever need them, do not hesitate to pick up the phone and give them a call.
Loveth Okpedo
Loveth Okpedo
2024-03-12
Very professional, very transparent, over all a great experience
Bee L
Bee L
2024-02-28
Amazing experience with Spodek! Very professional lawyers who take your case seriously. They treated me with respect, were always available, and answered any and all questions. They were able to help me very successfully and removed a huge stress. Highly recommend.
divesh patel
divesh patel
2024-02-24
I can't recommend Alex Zhik and Spodek Law Firm highly enough for their exceptional legal representation and personal mentorship. From the moment I engaged their services in October 2022, Alex took the time to understand my case thoroughly and provided guidance every step of the way. Alex's dedication to my case went above and beyond my expectations. His expertise, attention to detail, and commitment to achieving the best possible outcome were evident throughout the entire process. He took the time to mentor me, ensuring I understood the legal complexities involved to make informed decisions. Alex is the kind of guy you would want to have a beer with and has made a meaningful impact on me. I also want to acknowledge Todd Spodek, the leader of the firm, who played a crucial role in my case. His leadership and support bolstered the efforts of Alex, and his involvement highlighted the firm's commitment to excellence. Thanks to Alex Zhik and Todd Spodek, I achieved the outcome I desired, and I am incredibly grateful for their professionalism, expertise, and genuine care. If you're in need of legal representation, look no further than this outstanding team.

Beneficiary Inducement Statute

The Beneficiary Inducement Statute (42 U.S.C. § 1320a-7a(a)(5)) imposes lofty civil cash penalties on anyone who offers or furnishes remuneration to a federal healthcare beneficiary that person is aware (or should be aware) is likely to bias that beneficiary to order or receive any product or service from a particular provider, practitioner, or supplier.

Offering valuable gifts raises quality and cost concerns since providers may have an economic incentive to offset additional costs attributable to giveaways by providing unnecessary services substituting cheaper lower-quality services. The use of giveaways also favors large providers with greater financial resources for such activities disadvantaging smaller providers and businesses according to OIG Special Advisory Bulletin covering Offering Gifts and Other Inducements to Beneficiaries (August 2002) (OIG SPB 2002).

Exemptions: The most important exceptions are waiving coinsurance deductible provided on an individualized basis based on good faith determination of financial need remunerations of nominal value defined as less than $15 per item less than $75 annually [1] i.e., t-shirts subject interpretation restrictions.

Penalties: Sanctions include monetary penalties amounting up $10,000 for each product/service billed in violation temporary permanent exclusion from participation in federal healthcare programs recompense equal three times government’s damages three times amount billed for each item/service.

False Claims Act

In the False Claims Act (31 U.S.C. § 3729 et seq.), individuals entities can be held liable for submitting false fraudulent payment claims government healthcare programs. Examples include physicians billing Medicare unnecessarily laboratories billing Medicare tests never administered etc.

Punishment includes financial penalties ranging between $10,781.40 on the low end to as lofty as $21,562.80 on the high end for every false claim three times amount of damages inflicted on government temporary permanent exclusion from participation in federal healthcare programs criminal prosecution.

Conclusion

In conclusion, paying patients is risky and may lead to criminal charges since it violates fundamental laws that govern patient bribery cases such as the Anti-Kickback Statute, Beneficiary Inducement Statute, and False Claims Act. The penalties for violating these laws are severe and can result in fines or imprisonment. Therefore, it is essential to avoid any form of remuneration that persuades patients into choosing specific providers’ prescriptions medical services through inappropriate means like giving them gift cards or other incentives.

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Todd Spodek

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JEREMY FEIGENBAUM

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ELIZABETH GARVEY

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CLAIRE BANKS

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RAJESH BARUA

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CHAD LEWIN

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