Philadelphia Health Care Lawyers: Self-Referral and Anti-Kickback Regulations

The government has several different ways of protecting the health care system from abuse and fraud. The Federal Anti-Kickback Statute, enacted in 1972, penalizes anyone who offers something of value in an effort to encourage the referral of federal health care business.

Congress also passed self-referral legislation known as the “Stark Law” in the early 1990’s prohibiting Medicare and Medicaid payments when a physician refers any of several health services to an entity where that physician has a financial relationship.

Where self-referral laws apply only to physicians, anti-kickback laws apply to anyone who knowingly offers, pays, or receives reimbursement in order to induce business reimbursed by Medicare or Medicaid. Stark Law violations and Anti-Kickback Statute violations carry severe penalties.

Penalties for Violations

At the least, violators are subject to denial of the payment for the health service provided or refunds for the payments made. The most serious penalties include exclusion from Medicare and Medicaid programs and fines ranging from $15,000 to $100,000 for schemes attempting to circumvent the system, and even jail time. The Department of Health and Human Services, Department of Justice, and Centers for Medicare and Medicaid Services (CMS) are responsible for enforcing the Stark Law violations.

Safe Harbor Regulations are guidelines defining practices that are not considered bribes or kickbacks, and are permissible by law. These Safe Harbor relationships allow financial and referral relationships between providers and physicians. These relationships are safe from prosecution under Stark Laws or Anti-Kickback Statutes.

Factors that determine Safe Harbor relationships are varied, but all are designed to ensure that health care referrals are issued in the best interest of patients, not the pockets of physicians.

Philadelphia Health Care Lawyers at Sidney L. Gold & Associates, P.C. Help Health Care Providers Stay Stark Law and Anti-Kickback Compliant

Health care providers should be focused on patient care. Philadelphia health care lawyers at Sidney L. Gold & Associates, P.C. provide skilled counsel to ensure physicians stay Stark Law and Anti-Kickback Law compliant. We can also manage the legal issues surrounding recruiting, credentialing, and payments. We are are full service health care lawyers. We handle doctor and professional licensing, employment contracts, and defend health providers facing disciplinary action. Contact us online or call our Philadelphia offices at 215-569-1999 to discuss your case today. We proudly serve clients throughout New Jersey, Pennsylvania and New York.