Anti-Kickback Statutes and Stark Law
Federal law strictly prohibits, with a few enumerated exceptions, the exchange of anything of value for access to payments from a government healthcare plan, like Medicare and Medicaid. Specifically, what are known as the Anti-Kickback and Stark Laws, are intended to protect patients from unethical medical or corporate entities who seek to improperly profit off their patients. Hence, any individual or organization who violates these statutes can be held liable either criminally and/or civilly. However, since the US healthcare industry is so massive, nearly 20% of the national GDP, its often quite difficult to uncover fraudulent schemes amongst all the legitimate healthcare transactions. This is when the government relies on folks who blow the whistle on these kickbacks or illegal referrals.
Our Whistleblower Practice is within the Complex Litigation Group, and we represent whistleblowers across the country. Our firm has represented more than 100,000 clients, often recovering multimillion-dollar settlements in the name of justice, and we’re prepared to offer you the same results that made us who we are today. You’re making a courageous effort to enforce fairness and justice across the entirety of the healthcare industry, and we’re prepared to do whatever it takes to help you find success in your whistleblower lawsuit.
If you have evidence of anti-kickback or stark law statutes, contact us today for more information on how to use your evidence to fight for the greater good.
Understanding Anti-Kickback Statutes and Stark Law
The Stark Law, originally known as the Patient Referrals Act, limits referrals to designated health services, such as lab testing, prescription drugs, hospital services, and complete medical equipment. This law only applies to relationships with physicians, and it doesn’t require proof of intent to induce referrals before the activity is considered a violation. The legislation also establishes strict rules for any business dealing that would otherwise be considered a referral, such as term limits, and specific documentation as to what is being exchanged in the transaction. Despite the exceptions to the law, any referral where a doctor or health organization fraudulently benefits from the relationship is considered a violation, such as referring patients to an imaging company that the doctor has invested in. The Stark Law can be very complicated for someone without any legal experience, so it’s recommended to team up with an experienced lawyer if you believe you’ve witnessed a violation.
The Anti-Kickback Statute covers a wider range of activities than the Stark Law. It also extends to all individuals or entities who are “in a position to arrange or recommend government health plan medical services. However, unlike the Stark Law, violations of the Anti-Kickback Statute require proof of intent to induce referrals, meaning that any whistleblower who wishes to expose a potential violation must also have solid evidence that the organization knowingly and intentionally tried to persuade a third party into a referral. Any organization that violates the Anti-Kickback Statute and bills for payment through a government health plan simultaneously also violates the False Claims Act (FCA) and can be subject to penalties through a civil lawsuit.
Below are a but a few examples of Stark or AKS violations:
- Hospitals or medication manufacturers offering investment opportunities, joint ventures, or opportunities to buy other healthcare companies to a doctor in a position to make a referral
- A hospital paying “performance bonuses” that are related to the number of x rays and lab results ordered by the facility
- A prescription drug company paying kickbacks to pharmacies to encourage them to switch patients’ prescriptions.
- A large healthcare organization purchasing a smaller physician practice for an inflated price, then requiring the physician to continue their employment there while referring business to the healthcare organization.
- A nursing home allows a specialized medical group to use an owned office for a free or discounted rate to encourage reduced prices
If you have evidence of Anti-Kickback Statute or Stark Law violations occurring at your workplace or any other healthcare facility, contact our whistleblower team today for more information on how to hold the abuser accountable and maybe win a financial reward.