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Potential Risks Involved in New Health Care Laws

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The Department of Health and Human Services recently announced proposed changes to Stark Law and the Anti-Kickback Statute (AKS) that will continue to protect against Medicare and Medicaid fraud, but offer physicians greater flexibility to provide coordinated health care for their patients. The proposed changes will allow exceptions to these laws and ease the burden of compliance for physicians.

The Stark Law is designed to prevent abuse of the Medicare and Medicaid system by prohibiting physicians from referring patients for medical services to anyone where they or an immediate family member has a financial relationship.  Compliance with this law is difficult for physicians that aim to coordinate health care services for their patients. The AKS limits physicians from referring patients to a health care provider that offers any type of financial reward or object of value for services that are paid for by federal health care programs, such as Medicare and Medicaid. The AKS covers a wide range of health care services and falls under criminal law.

The proposed changes to the Stark Law and the AKS will allow physicians more freedom to refer Medicare and Medicaid patients to colleagues and network physicians to make patient care more efficient and successful. The proposed changes are a result of collaboration between the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG). The CMS and OIG acknowledged that the current structure of Stark Law and AKS were putting a significant compliance burden on physicians. The two agencies created the proposed changes to support the Health and Human Services Regulatory Sprint to Coordinated Care proposal, initiated in 2018.

What are the Risks Involved in the Proposed Changes?

Penalties for non-compliance or violation of Stark Law or the AKS carry heavy legal consequences that include:

  • No payment or refunds for services rendered for Stark Law violations
  • Civil penalties up to $15,000 per falsified claim
  • Felony conviction with prison terms up to 10 years and fines up to $100,000 for each AKS violation
  • False Claims Act violations carry fines between $11,181 and $22,363, plus three times the government’s damages

Stark Law and the AKS are enforced by the federal government. Claims for fraudulent Medicare and Medicaid services can fall under the False Claims Act.  These claims can be made under qui tam laws and carry a possible award of 15 to 25 percent of government damages. Stark Law and AKS violations can sometimes fall under the False Claims Act, making it lucrative for those with knowledge of fraud to come forward.

Philadelphia Physician Lawyers at Sidney L. Gold & Associates, P.C. Help Health Care Providers with Stark Law and Anti-Kickback Statute Compliance

If you are a physician or health care provider concerned about compliance with the proposed changes to the Stark Law and Anti-Kickback Statute, contact the Philadelphia physician lawyers at Sidney L. Gold & Associates, P.C. Call us at 215-569-1999 or contact us online to schedule a free consultation today. Located in Philadelphia, we serve clients throughout Wilkes-Barre, Scranton, northeast Philadelphia, Bucks County, Chester County, Delaware County, and Montgomery County.

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