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Physicians, nurses, dentist, physician assistants, hospitals and medical services facilities are part of a network of providers that provide much needed services to the public. In turn, imaging centers, drug companies and other ancillary services vie for patient referral business among the former group. This is especially true for Medicare and Medicaid reimbursements.
As more healthcare practices and service providers compete for those referrals by offering incentives to doctors and pharmacies.
Because of this, federal anti-kickback laws are imposing strict penalties for anyone who willfully propositions, pays or receives kickbacks in exchange for business and services that are paid through Medicare and Medicaid insurance programs. Anyone receiving payments such as money, discounts on services or fees, or gifts associated with Medicare and Medicaid patients are considered in violation of this federal law.
Some stipulations of the law can be confusing; safe harbor regulations can also draw a fine line between what is legal and what is illegal activity. Providers need competent representation from Philadelphia Stark Anti-kickback lawyers for clarity on what is a violation and what is not.
Anti-Kickback Law Violations
Compliance with federal, state and local anti-kickback laws is essential to maintaining a solid practice in the healthcare industry. In one act, you could fall prey to attractive incentives. However, if you are aware of the law and have a good compliance program in place, you will not be easily swayed.
Being offered incentives for giving office space to a particular product is part of sales. However, the line is crossed when a physician or pharmacist is given the incentive because they will only give the product to Medicare and Medicaid customers, the legal line has been crossed.
Incentives can be as much as an expensive trip or less expensive as a gift card. It does not matter if it is done in exchange for favoritism that violates anti-kickback laws.
Safe Harbor Stipulations
Safe harbors are another part to this that healthcare providers must be cautious about violating. Safe harbor stipulations muddle an already complicated process when trying to determine which incentives are appropriate under the regulations.
For instance, referrals that fall under the safe harbor law include:
• Medical centers
• Teaching hospitals
• Affiliated healthcare centers
• Ambulatory surgical centers
• Electronic health record services
The following are included in the safe harbor regulations:
• Physician personnel recruitment
• Investment benefits
• Payments to legitimate employees
• Certain discounts
• Physician personnel recruitment
These regulations provide a wider range of permissible incentives. However, it is still possible to misuse these as well, only to create more complicated legal situations.
Penalties for Anti-Kickback Laws Violations
Healthcare providers such as physicians, dentists and hospitals can face civil and criminal penalties if they violate the federal anti-kickback laws. Civil penalties can lead to a maximum of $50,000 in fines per violations.
Criminal penalties may involve up to five years in prison and fines up to $25,000. The healthcare professional may also be prohibited from participating in Medicare and Medicaid. Naturally, this could end the career of these professionals.
Anti-kickback laws usually fall under the False Claims Act when false bills are filed with either one of these government-sponsored health insurance programs. Judges are taking these violations very seriously; a recent judgement led to a $150 million settlement when a major healthcare provider submitted false Medicare bills.
Philadelphia Stark Anti-Kickback Lawyers Ensure Compliance
The best way for you to avoid a multi-million dollar judgement or even jail time is to hire a knowledgeable lawyer from Raiser & Kenniff, PC. We can help you develop a compliance program ensures everyone is on the same page about anti-kickback statutes.
It is easy for an employee to make one million dollar error. By the time you find the mistake, the federal government could be pursuing charges. The business environment has seen many fraudulent acts and abuses lately.
You do not want your career and practice to become part of this widespread sting. Let us help you get on track before investigators and auditors have your practice in their crosshairs.
If you have already been contacted, we will represent you to the fullest and build a solid defense so you can avoid the stiff penalties that come with violating these laws. We have the legal expertise to protect your career and business.