Philadelphia Health Care Lawyers

Sidney L. Gold & Associates Represent Physicians, Executives and Medical Establishments on New Federal Anti-Kickback Laws

Physicians, physician assistants, nurses, dentists, medical services facilities and hospitals make up a network that has become a highly competitive business. Drug companies, imaging centers, medical facilities and service providers consistently vie for the business of patient referrals from medical personnel, especially those who are reimbursed through Medicare and Medicaid. The competition has become fierce as more and more medical practices and service providers compete for patient referrals by offering doctors, pharmacies and medical facilities attractive incentives.

Federal, state and local anti-kickback laws are now imposing strict penalties for those who willfully proposition, pay or receive kickbacks, bribes or rebates in exchange for business and services paid for by Medicare and Medicaid. Anyone receiving money, gifts or discounts on services or fees associated with Medicare and Medicaid patients are in violation of these federal laws. Stipulations in these laws can be confusing and safe harbor regulations in the laws can put a fine line between legal and illegal activity. Philadelphia’s reputable and competent health care attorney, Sidney L. Gold, can ensure that physicians and executives remain compliant.

Violations of Anti-Kickback Laws

Philadelphia health care lawyer, Sidney L. Gold, founder and shareholder of the health care and employment law firm of Sidney L. Gold & Associates has a 35 year history of successfully helping clients avoid criminal charges and civil penalties by ensuring compliance with federal, state and local anti-kickback laws. It can be easy for medical professionals and facilities to fall prey to attractive incentives that are presented by persistent medical salesmen and women.

Pharmaceutical sales has become a very profitable business with high earning potential for salespeople who are able to market drugs that are especially useful to disabled and elderly patients covered by Medicare and Medicaid. The goal of the salesperson is to get their drug, product or service out to as many people as possible in a short amount of time so that they increase their potential as a brand leader. Offering incentives for trying or giving shelf space to a product is part of the sales game, but when incentives become the primary source for a physician or pharmacist to agree to offer or use the drug specifically to Medicare and Medicaid customers, the legal line is crossed.

Incentives such as expensive trips or gift cards to lush restaurants in exchange for doctors prescribing certain medications violate the anti-kickback laws. Cash incentives; free or reduced rent for medical facilities; discounted medical services fees offered by nursing homes and assisted living facilities in exchange for patient referrals and pharmacies that offer Medicare and Medicaid customers cash incentives to transfer prescriptions also violate these federal laws.

Hospitals, diagnostic testing centers, physical and cognitive rehabilitation facilities and imaging centers can also become entangled in their own illegal incentive programs. Hospitals that accept kickbacks or cash incentives for referring Medicare and Medicaid patients are in violation of these federal laws. Home health companies are experiencing rapid growth as more and more senior citizens are using their services to avoid expensive nursing care facilities. When these businesses offer physicians monetary incentives for patient referrals, or provide below market value coordination services to physicians who refer Medicare and Medicaid patients, they too are violating anti-kickback laws.

Safe Harbors

Clients of Philadelphia health care lawyer, Sidney L. Gold, benefit from his extensive knowledge and experience in employment and health care law when they work together to ensure compliance with federal anti-kickback laws. These laws can be cumbersome to navigate, and safe harbor stipulations can complicate the process of determining which types of incentives are permissible under these regulations.

Referrals to affiliated health care centers, teaching hospitals and medical centers, as well as ambulatory surgical centers fall under the safe harbor regulations; along with electronic prescribing and electronic health record items and services. Warranties, certain discounts, payments to legitimate employees, physician and medical personnel recruitment and investment benefits are also included in safe harbor regulations. While these regulations provide a wider range of permissible incentive strategies, they can also be misused and create complicated legal situations.

Penalties for Violations of Federal Anti-Kickback Laws

Physicians, physician assistants, dentists, hospitals and medical providers face criminal and civil penalties when found to be in violation of federal anti-kickback laws. Criminal penalties such as prison terms up to five years, fines up to $25,000 and prohibiting participation in federal health care programs like Medicare and Medicaid can end a medical career or business. Civil penalties can include fines up to $50,000 per violation.

Violations of anti-kickback laws can also fall under the False Claims Act when medical facilities file fraudulent bills with government sponsored health care programs. Recent litigation has proven just how seriously judges are taking the federal anti-kickback and False Claims Act legislation. The U.S. Department of Justice recently imposed a settlement of $150 million on a major health care provider when they submitted falsified billings to Medicare. In another settlement, Omnicare, which is the largest nursing home pharmacy in the country, was ordered to pay $124 million to settle claims that they offered illegal incentives to nursing homes in exchange for using their services exclusively.

Personal Legal Services Provided by Philadelphia Health Care Law Firm, Sidney L. Gold & Associates, Ensures Compliance with Federal Anti-Kickback Laws

Philadelphia health care attorney, Sidney L. Gold, founder and shareholder of Sidney L. Gold & Associates has designed a new approach to providing health care law services to physicians, physician assistants, nurses, medical personnel, executives and health care businesses. By offering his personal legal counsel and representation to medical providers, Sidney L. Gold will enable his clients to avoid stiff penalties for non-compliance to federal anti-kickback laws and regulations. With over 35 years’ experience in Pennsylvania, New Jersey, and New York employment and health care law, we will provide the legal expertise necessary to protect and enhance the careers of medical professionals, executives and businesses.

Call us at 215-569-1999, or complete an online contact form to schedule a consultation today. With offices conveniently located in Philadelphia, Pennsylvania, we offer personalized services to our clients.