In addition, the Office of the Inspector General (“OIG”) for the Department of Health and Human Services (“HHS”) can pursue civil penalties of up to $50,000 per violation plus three times the amount of any government overpayment. Anti-kickback Statute, which prohibited payment of kickbacks, bribes, or rebates for the referral of Medicaid or Medicare patients.' To protect patients from this kind of harm, Congress passed the Anti-Kickback Statute in 1986. “Referrals” under the Anti-Kickback Statute include “any item or service for which payment may be made in whole or in part under a Federal health care program.” While the Anti-Kickback Statute covers a broad range of activity, it also requires a showing of … Notably, these penalties can be imposed on both parties involved in the illegal kickback arrangement—i.e., the party receiving the kickback and the party making the kickback—upon a showing that the violation was “knowing and willful.” Penalties for Anti-Kickback violations also frequently include a period of debarment or exclusion from participation in Medicare, Medicaid, and all other federal plans and programs that provide health benefits. Since the statute defines The Stark Law is one of the two main federal statutes that deals with remuneration related to improper referrals, with the other being the Anti-Kickback Statute. Generally, the Anti-Kickback Statute is a criminal statute that prohibits a person or entity from exchanging, or offering to exchange, anything of value, in an effort to induce or reward the referral of Federal health care program business. … Any healthcare provider—whether it is a hospital, laboratory, pharmaceutical company, hospice, or home health agency—is also prohibited from submitting claims to Medicare or Medi… It looks like your browser needs an update. in return for referring an individual to a person for the furnishing . This website presents general information about Barrett & Singal and is not intended as legal advice nor should you consider it as such. The Anti-Kickback Statute makes it a federal criminal offense to offer, pay or accept compensation in exchange for referrals for healthcare services that are covered by the federal healthcare programs. Anti-Kickback Statute. While the Anti-Kickback Statute applies to all federal healthcare programs, Stark Law applies to Medicare and Medicaid only. While designed to promote fair marketing, it also gives protection to Medicare/Medicaid patients, who are typically elderly or disabled. Unlike Stark, anyone can violate the statute. The OIG has identified twenty-five types of safe harbor arrangements. The criminal penalties include fines of up to $25,000 and five years’ imprisonment. The Anti-Kickback Statute. Congress declared that any conduct violating the statute would result in a criminal misdemeanor punishable by fines of … T 401.454.0400 The complex legal landscape governing these Anti-Kickback Statute issues coupled with the federal government’s commitment to prosecuting violators, and levying significant penalties against them, represents a lethal combination for healthcare organizations and personnel. In June 2014, HHS issued a Special Fraud Alert identifying arrangements between laboratories and physicians as presenting a substantial risk of fraud and abuse under the Anti-Kickback Statute. 5. That penalty was dwarfed, however, by the $24.5 million settlement a group of clinics and physicians in Alabama paid to settle Anti-Kickback and Stark Law allegations that the clinics kicked back a percentage of Medicare reimbursements for tests and procedures the physician group referred. Name one way in which the Anti-Kickback Statute differs from the Stark Law. Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity for the provision of designated health services ("DHS") if the physician (or an immediate family member) has a financial relationship with that entity.. One intent of safe harbor legislation was to enhance the effectiveness and efficiency in the delivery of health care. Suite 1320 The Anti-Kickback Statute is a criminal statute, but it provides both criminal and civil penalties for violations. According to the Court, the scope is quite broad, even extending to situations where the … Penalties for violating the Stark Law may include denial of payment to the DHS entity, civil money penalties (up to $25,820 per prohibited referral and … not just physicians. ... No. Second, the Stark Law is narrower. Boston, MA 02108, One Richmond Sq. 3. prohibits a person from receiving anything of value in exchange for referring a person to a physician for treatment where any portion of the referred patient's treatment fee is payable pursuant to a "Federal health care program." Under the Anti-Kickback Statute, a company commits fraud when it offers doctors and other healthcare providers financial incentives to use the company’s products or services, for which payment may be made under Medicare, Medicaid or other federally funded healthcare programs. Oh no! Remuneration includes which of the following. Explain the Anti-Kickback Statute and what is prohibited as well as safe. In other cases, there are instances where people make referrals to the doctor’s office and receive a payment from the doctor for doing so. The Anti-Kickback Statute, codified at 42 U.S. Code § 1320a–7b(b), is an American federal law which imposes criminal and, particularly in association with the federal False Claims Act, civil liability on those that knowingly and willfully offer, solicit, receive, or pay any form of remuneration in exchange for the referral of services or products covered by any federal healthcare program … Most of these laws are based on the Statute, and are similar in many respects. STATUTE. Of course, healthcare providers make many referrals that do not violate the Anti-Kickback Statute by taking advantage of the “safe harbors” that are written into the Statute and exempt certain referral arrangements from its prohibitions. The Federal anti-kickback statute is an intent-based, criminal statute that prohibits intentional payments, whether monetary or in-kind, in exchange for referrals or other Federal health care program business. Although these two laws are similar, there are several important distinctions between the Stark Law versus The Anti-Kickback Statute. This trend toward stricter enforcement and larger penalties has been ongoing for years with no end in sight. In … Each safe harbor protects only those arrangements _______________________________. By clicking "Accept," you acknowledge that we have no obligation to maintain the confidentiality of any information you submit to us unless we already represent you or unless we have agreed to receive limited confidential material/information from you as a prospective client. The False Claims Act, From the Blog: The AKS is a criminal statute that prohibits transactions intended to induce or reward referrals for items or services reimbursed by the federal health care programs. The Anti-Kickback Act of 1986, 41 U.S.C. Tap again to see term 👆. What the Anti-Kickback Statute Prohibits The Anti-Kickback Law or Anti-Kickback Statute (AKS) is the federal criminal law that forbids kickbacks involved in federal health care programs. However, a violation of the Stark Law must involve a referral relationship between a physician and an entity. It is a general description of prohibitions and permissions. If convicted, penalties include ________________________________. First, unlike the Anti-Kickback Statute which includes civil and criminal penalties, the Stark Law is exclusively a civil enforcement statute. This type of zealous prosecution often results in harsh penalties for healthcare providers found to have committed a violation. . Although these two laws are similar, there are several several important distinctions between the Anti-Kickback Statute versus the Stark Law. Anti-Kickback violations also usually constitute violations of the False Claims Act, meaning that Anti-Kickback investigations can likewise result in fraud liability. The illegal kickbacks can be cash payments, but often include other items of monetary value, such as gifts, free or discounted supplies or services, and travel.Hospitals and other companies … In addition to the federal Anti-Kickback Statute, approximately 36 states and the District of Columbia also have laws that prohibit paying remunerations for … Some of the “safe harbors” that are most often used by accused providers exempt the following from prosecution under the Anti-Kickback Statute: (i) referrals made as part of an employment or professional services arrangement; (ii) payments made for the lease of equipment or of office space; and, (iii) certain payments made for the purposes of health practitioner recruitment. Are typically elderly or disabled thank you for your interest in Barrett &.. 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