How Attorneys Challenge Allegations of Healthcare Kickbacks
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Healthcare kickbacks are unfortunately still prevalent today, leading to inflated costs and barriers to quality care. As attorneys well-know, kickbacks come in many forms – from improper physician referrals to waiving patient copays. When kickback allegations arise, attorneys have an array of options to mount an effective defense.
The legal landscape here is complex. The federal Anti-Kickback Statute (AKS) broadly prohibits exchanges of anything of value to induce or reward referrals of federal healthcare business. Violations carry stiff penalties – up to $100,000 in fines per violation, 10 years imprisonment, and exclusion from federal programs. States have enacted similar restrictions.
Yet courts recognize that in the intricate healthcare space, not all financial ties are nefarious kickbacks. Legitimate, arm’s length business arrangements are lawful. And medical decision-making should not be micro-managed. So judicial interpretations, regulatory safe harbors, and OIG advisory opinions offer guideposts for acceptable practices. Counsel can leverage these resources to fend off overzealous accusations.
Scrutinizing The Accusations
The first task is scrutinizing the kickback allegations. Counsel should probe whether the financial relationship truly poses a risk of improperly steering referrals. Or does it facilitate sound patient care and follow industry norms?
For example, hospitals often provide subsidies to recruit specialists to underserved communities. The financial support can ensure patient access to quality services. Similarly, gainsharing arrangements that reward physicians for improving care efficiency can benefit patients. While the compensation impacts referrals, the goal is enhancing value – not just padding profits.
Counsel can argue that these ties comport with ethical duties to patients and community health needs. They do not betray patient trust like schemes where doctors needlessly admit patients or over-prescribe opioids just to profit from kickbacks. Painting a compelling picture of the arrangement’s patient focus is key.
Citing Regulatory Guidance
Another avenue is citing regulatory guidance blessing similar practices. For example, Anti-Kickback safe harbors allow hospitals to cover costs of electronic records technology provided to physicians. And doctors can invest in ambulatory surgery centers sending them referrals if specific criteria are met. By analogizing to such recognized models, counsel can ease liability fears.
Precedential OIG advisory opinions also indicate approval of certain financial ties unlikely to encourage abuse. Counsel can explain how the arrangement under scrutiny matches or exceeds protections in such opinions. Showing adherence to factors OIG has endorsed adds force.
Of course, caveats apply. Meeting a safe harbor or prior opinion is not guaranteed safety. But it shows the relationship has indicia of propriety from informed regulators. That can deter charges or help achieve more lenient settlements.
Advancing Sound Legal Arguments
Where regulatory guidance falls short, counsel can invoke key court rulings to fight kickback allegations. Several doctrines may apply to demonstrate the defendant’s innocent mindset.
The “one purpose” test says an arrangement violates AKS only if one purpose (not just the primary purpose) is inducing referrals. This sets a fairly high bar for prosecutors to prove illegality. Counsel can argue business goals like improving efficiency or quality primarily motivated the tie. Referral growth was just a collateral consequence, not a purpose.
Relatedly, the “good faith” defense protects arrangements with lawful goals that incidentally influence referrals. Counsel might contend the defendant had a genuine belief that structuring and safeguards rendered the deal legal. That good faith, even if deemed mistaken, helps negate wrongful intent.
Counsel can also leverage the rule of lenity, which directs ambiguous statutes like AKS to be interpreted narrowly. This suggests excluding arrangements where kickback concerns seem reasonably debatable. Lenity aims to ensure fair notice so people know what deals risk punishment. Due process reinforces applying AKS narrowly absent clear abuse.
Promoting Cooperativeness
If kickback concerns have some merit, counsel still has tools to mitigate outcomes. Emphasizing the defendant’s cooperativeness and remedial efforts can yield prosecutorial leniency and lower penalties.
Stressing upfront that the defendant always strove to comply with an ambiguous law – and is ready to implement fixes recommended by the government – casts cooperation in a favorable light. Admitting imperfections in the financial relationship while highlighting its positive goals and impacts can also resonate.
Proposing enhanced training, audits, documentation, or compensation adjustments often furthers constructive dialogue with authorities. Settlements may incorporate such reforms rather than exclusions, bars, or closures that could leave patients stranded. Showing willingness to remedy issues reveals shared objectives to nurture ethical practices.
Conclusion
Allegations of healthcare kickbacks demand thoughtful navigation by counsel. But attorneys can deploy several strategies to rebut accusations or mitigate outcomes. Scrutinizing the specific financial tie at issue, citing regulatory guidance blessing similar practices, advancing sound legal arguments, and promoting cooperativeness to enhance compliance all offer promising paths to defend these complex cases. While kickback laws remain stringent to protect program integrity, counsel has room to advocate arrangements furthering quality, affordable patient care.