Anti-kickback laws were created to combat unethical behaviors and actions across the health care industry, such as fraud, abuse, and waste. Along with the Stark Law, the Anti-Kickback Statute (AKS) keeps checks on physicians and other medical professionals, and both need to be followed to the letter to avoid fines and other serious penalties.
According to the Centers for Medicare and Medicaid Services, kickbacks cause corruption, increased costs for health care, and overutilization. These illegal actions can also promote non-competitive, unfair services, and steer patients away from legitimate services and therapies. The AKS is a federal, criminal statute prohibiting medical professionals from exchanging (or offering to exchange) anything of value with the intent of rewarding or inducing business referrals that are reimbursable through federal health care programs.
Here are a few examples of kickbacks:
- Excess compensation for a medical directorship.
- Waived copayments.
- Low rent/free office space.
Those who violate the AKS may face civil and criminal penalties and severe consequences. Offenders might be fined per incident, have Medicare and Medicaid program exclusion, and can go to prison for up to five years.
What Is the Stark Law?
Stark Law also applies to Medicare and Medicaid but in different ways. Stark Law is a set of federal civil laws. They prohibit physicians from self-referrals of Medicare and Medicaid patients to entities that provide designated health services when the physician has a financial relationship with the entity. Although Stark Law imposes high financial penalties, the charges are non-criminal.
Physicians who violate the Stark Law may be required to pay as much as $15,000 for each service proven to be illegal, plus three times the amount of the inappropriate payment received. Other consequences include being excluded from state health care programs and Medicaid, plus additional civil penalties.
An example of a Stark law violation might be a hospital offering a physician the opportunity to buy into a surgical center at a very low price if the physician agrees to refer a certain number of new patients per month.
How AKS and Stark Law Violations Are Prevented?
Medical organizations can maintain compliance through effective programs that follow guidelines from the Department of Health and Human Services, such as:
- Clearly written procedures, policies, and conduct standards.
- Effective communication.
- Having a designated compliance officer who manages a compliance committee.
- Effective education and training.
- Ongoing internal monitoring and auditing.
- Enforcing compliance standards through disciplinary methods.
- Responding promptly when offenses are detected.
- Undertaking appropriate, corrective actions.
Physicians and other medical professionals who are unfamiliar with how the laws work might find themselves in need of legal assistance if charged with a violation. An experienced lawyer might be able to help.
Philadelphia Physician Lawyer at Sidney L. Gold & Associates, P.C. Can Give Legal Advice on AKS and Stark Law Violations
Physicians have to follow the law if they want to continue practicing, and Stark Law and AKS violations can ruin careers. If you need legal help due to such a violation, speak with our Philadelphia physician lawyer at Sidney L. Gold & Associates, P.C. We will fight to protect your rights and are available to answer your questions. Call us at 215-569-1999 or complete our online form to schedule a free consultation. Located in Philadelphia, we serve clients in Southeastern Pennsylvania, including Wilkes-Barre, Scranton, Northeast Philadelphia, Bucks County, Chester County, Delaware County, Lehigh County, and Montgomery County.