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What Are the Limits on Referrals?

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Philadelphia Anti-Kickback Lawyer at Sidney L. Gold & Associates, P.C. Represents Health Care Professionals.

Ideally, patients in the health care system have a team of providers working together to help them achieve optimum health and wellness. However, there are strict laws in place that often make it challenging for clinicians to collaborate.

Self-referral and anti-kickback laws are designed to encourage fair competition in the marketplace. The Anti-Kickback Statute makes it a felony for anyone who knowingly and willingly pays, offers, solicits, or receives kickbacks for referrals for services paid by Medicaid and other government health services. Penalties include fines and jail time.

The Stark Law, also known as the Physician Self-Referral Law, prohibits physicians from referring Medicaid or Medicare patients for medical services if those services would benefit the doctor or someone in their immediate family. The Stark Law was enacted to prevent patients from being referred for unnecessary or excessively costly treatments strictly for profit.

These laws can apply to any of the following:

  • Clinical lab services.
  • Home-health services.
  • Imaging services.
  • In-patient and outpatient health services.
  • Occupational therapy.
  • Orthotic and prosthetic devices.
  • Physical therapy.

Are There Exceptions?

One exception to anti-kickback laws applies to a growing number of medical practices working to offer comprehensive care. Physicians are permitted to order lab work and/or radiology to be preformed in their own office.

Also, referrals are permitted when a bona fide employment relationship exists in relation to the physician’s compensation. That means their compensation is determined in advance, reflects the fair market value, and is not determined by the number of referrals made. Every decision and service should be based first and foremost on the patient’s welfare and best interests.

What if You Are Accused of Violating the Anti-Kickback Statute?

Allegations of anti-kickback violations are not uncommon, especially in medical specialties with a limited number of practitioners. Physicians may have a good working relationship with certain outside specialists and practices, but that does not mean they are profiting off those referrals.

Health care providers accused of kickbacks have a lot to lose. Penalties for anti-kickback violations can include exclusion from participation in Medicare/Medicaid, heavy fines, and even jail time. For some, these actions can be career-ending. It is unwise to try to navigate the legal system alone.

Before you do anything, choose a firm with a legal team focused on health care law. With skilled legal counsel, you can possibly avoid consequences.

Philadelphia Anti-Kickback Lawyer at Sidney L. Gold & Associates, P.C. Represents Health Care Professionals

A Philadelphia anti-kickback lawyer at Sidney L. Gold & Associates, P.C. can provide legal guidance on a wide range of health care legal matters. Call us at 215-569-1999 or contact us online 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.

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