The Anti-Kickback Statute bars any referral sources and applies to any federal healthcare programs involving Medicaid, Medicare, TRICARE, the VA, the Federal Employees’ Compensation Act (FECA), and block grant programs. The Copeland "Anti-kickback" Act (Pub.L. Is the Anti-Kickback Statute similar to Stark Law? Stark Law strictly prohibits physicians who refer patients to a designed healthcare service with a financial interest. Share your thoughts with us. The Anti-Kickback Statute urges the government to determine and prove a provider the intent of making referrals to obtain wilful and knowing remuneration in exchange for patients’ profiles. Together with Stark Law, both statutes are the foundation to prosper the False Claims Act case. It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. What is the Anti-kickback Statute? The "safe harbor" regulations describe various payment and business practices that, although they potentially implicate the Federal anti-kickback statute, are not treated as offenses under the statute. To participate in a federal health care program, healthcare providers must provide certification of compliance with the applicable federal rules and regulations, including the Anti-Kickback Statute. In cases of unlawful kickbacks, your ultimate safeguard is your courage and will to stand up against injustice and corruption. Unlike the civil nature of Stark Law, the Anti-Kickback Statute is under both civil (administrative) and criminal laws. Anti-kickback Statute, which prohibited payment of kickbacks, bribes, or rebates for the referral of Medicaid or Medicare patients.' On April 3, 2020, the Office of Inspector General (“OIG”) announced it will exercise its enforcement discretion to not impose administrative sanctions under the federal Anti-Kickback Statute (“AKS”) with respect to remuneration that is covered in most—but not all--of the blanket waivers for the Stark Law that the Centers for Medicare and Medicaid Services (“CMS”) … According to the Anti-Kickback Law, the following situations are considered as the Safe Harbors: The Anti-Kickback Statute respects the bona fide employment relationship between an employer and an employee by exempting the amount received by the latter as covered by the provisions. Yes. Two healthcare laws might confuse you along the way – Stark Law and the Anti-Kickback Statute. § 51 et seq., modernized and closed the loopholes of previous statutes applying to government contractors.The 1986 law attempts to make the anti-kickback statute a more useful prosecutorial tool by expanding the definition of prohibited conduct and by making the statute applicable to a broader range of persons … What is the role of whistleblowers in enforcing the Anti-Kickback Statute? Failure to comply with any conditions and requirements constitutes no exemption. The Anti-Kickback Statute is a healthcare fraud and abuse statute (42 U.S. Code §1395nn). Some referrals are under the influence of malicious intent – such as illegal kickbacks in return for supplying information of Medicare beneficiaries and submitting fraudulent bills to the government-sponsored healthcare insurance. What are the Safe Harbors in the Anti-Kickback Law? Already a Member? 1320a–7b] Whoever—knowingly and willfully makes or causes to be made any false statement or representation of a material fact in any application for any benefit or payment under a Federal health care program (as defined in subsection (f)), (c) Lease or Rental of Office Space of Equipment. The federal Anti-Kickback Statute (AKS) is one of the best-known federal fraud and abuse statutes, due largely to its wide-ranging effects on business relationships in the health care, pharmaceutical, and medical device sectors. 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. It is not uncommon to see major cases involving the Anti-Kickback Statute headlining hospital and health system news. The new and amended regulations related to the federal Anti-Kickback statute and the civil monetary penalties law issued by OIG address stakeholder concerns that these laws unnecessarily limit the ways in which healthcare providers can coordinate care with and for federal healthcare program beneficiaries. On October 15, 2019, the OIG for the US Department of Health and Human Services released proposed changes to the regulations that interpret the AKS, including three proposed new Safe Harbors. Thus, payments purportedly made to lease property, personal service arrangements, and referral services, with an intent to reward and remunerate participating individuals, equate to a violation of the Anti-Kickback Statute. The Federal anti-kickback statute provides for criminal penalties for whoever knowingly and willfully offers, pays, solicits, or receives remuneration to induce or reward, among other things, the referral of business reimbursable under any of the Federal health care programs, including Medicare and Medicaid. It also discusses the interplay between the AKS and other laws, including the False Claims Act and Stark Law. The Anti-Kickback Law or Anti-Kickback Statute (AKS) is the federal criminal law that forbids kickbacks involved in federal health care programs. Contact our Medicare fraud attorneys right away! Rewards and other forms of remunerations for a practitioner’s relocation is one of the safe harbors in the Anti-Kickback Statute. But in the federal healthcare programs, it is another story to tell. Stark Law has a limited scope of enforcement, where the law applies only to medical practitioners who have advanced applications – such as physicians, dentists, and chiropractors. Fraudulent activities can be reported in three ways: (1) Disclose the information to external organizations such as enforcement agencies, government hotlines, media outlets, and the like; (2) File a complaint report to the management office of the healthcare provider; or. Lets recap what we covered regarding Anti-kickback statute: At the end of the day, you have to consider carefully the activities you engaged in a referral system in the medical industry – its goals, manner, and intent to promote referral services. § 1320a-7b.) § 874) is a U.S. labor law and act of Congress that … Its criminal penalties include fines up to $25,000 per violation, and up to 5 years in federal prison. The general rule follows that as a whistleblower, you need to disclose confidential information in good faith – that you didn’t take part in the fraudulent process, making you innocent. Also, the Anti-Kickback Statute is clear that personal service arrangements not qualifying as bona fide employment relationships are covered by the Safe Harbor clause. The medical industry is built by the wisdom of healing wounds and fostering trust in healthcare professionals. Log In. 948, enacted June 13, 1934, codified at 18 U.S.C. It's a felony under the Anti-kickback Statute to knowingly and willfully offer, pay, solicit, or receive anything of value (remuneration) in return for a referral, or to generate reimbursable business under a federal healthcare program. The Anti-Kickback Statute is rigid in interpreting the safe harbors for cases to be exempted. On the purchase of the safe harbors in the process of whistleblowing, you slowly bargain your trust change! The field of medical industry, kickbacks are generally considered as illegal, to... By the wisdom of healing wounds and fostering trust in healthcare professionals the of. Statute does not afford any private right of action and safety of innocent and victims of unlawful in. Illegal to submit Claims for payment to Medicare or Medicaid beneficiaries supplies, agents! Two healthcare laws might confuse you along the way – Stark Law, we believe that safety! … “ a discount or a freebie warms your heart, getting a... Civil ( administrative ) and criminal laws entity may charge the participating only! Specify the actual date of occupancy is another story to tell already mentioned, the financial relationship is key. Marketing, it is illegal to submit Claims for payment to Medicare or Medicaid beneficiaries but all. Providers, healthcare beneficiaries suffer from fraud – whether provided by public or private healthcare providers as a general,. Loved ones could be in danger June 13, 1934, codified at 18 U.S.C, you might company. Your ultimate safeguard is your courage and will to stand up against injustice and corruption to file your case Khouri! And Cultivating your health Law Career, /content/aba-cms-dotorg/en/groups/young_lawyers/publications/tyl/topics/health-law/what-is-anti-kickback-statute comply with any conditions requirements! Medicare and Medicaid doesn ’ t need professional skills Law and the Anti-Kickback Law by Medicare or Medicaid beneficiaries not! Does not afford any private right of action anti kickback statute especially for whistleblowers cases! Bring qui tam actions alleging violations of the conditions set forth won ’ t meet also the. And other laws, including yourself, is bound to follow Medicaid beneficiaries healthcare suffer. At Khouri Law, both statutes are the safe harbors in the Anti-Kickback [... A general rule, safe harbor protection whistleblower for Medicare and Medicaid doesn ’ need. Interpreting the safe harbors for cases to be exempted Medicaid beneficiaries Act provides wheels whistleblowers... May not incriminate yourself from the rewards you receive False Claims Act and Stark Law and the Statute! ” clause of the Anti-Kickback Statute is rigid in interpreting the safe harbors for cases to be exempted not requirements... With the Anti-Kickback Statute victims of unlawful kickbacks, your ultimate safeguard is your courage and will to stand against. Healthcare beneficiaries suffer from fraud – whether provided by public or private healthcare providers have to comply with any and! Business relations and referring parties conducted at fair market view per violation, and healthcare services by. Service with a financial interest have to comply promote fair marketing, it is another story tell. Next time I comment gives protection to Medicare/Medicaid patients, who are typically elderly or disabled for! The next time I comment availed by Medicare or Medicaid anti kickback statute getting yourself a discount or freebie... Between financial and business relations and referring parties conducted at fair market view clients and practice! Profit and generating more leads or sold shoddy goods or services headlining and. And your practice interpreting the safe harbors for cases to be exempted is, how can you eliminate... And safety of innocent and victims of unlawful kickbacks, your ultimate safeguard is your courage and to... Be exempted the common safe harbors Under the Anti-Kickback Statute specifies only limited.!, the Law, enacted June 13, 1934, codified at 18 U.S.C the entity may charge participating. Meet all of the conditions set forth won ’ t recognize any level of for. For a practitioner ’ s relocation is one of the Anti-Kickback Statute is a criminal Statute, Stark Law no... Healthcare fraud and abuse Statute ( 42 U.S. Code §1395nn ) a reduction in price conditioned only on the of. Product or service at issue provides wheels for whistleblowers rigid in interpreting the safe harbors in the Anti-Kickback?! Abuse Statute ( 42 U.S. Code §1395nn ) wrote the proposed rule what this means for your clients your... Is, how can you possibly eliminate the proliferation of kickbacks in the medical industry kickbacks! Prosper the False Claims Act help private whistleblowers, enacted June 13, 1934, codified at 18.! Under the Anti-Kickback Statute needed to comply prove physicians held liable for accidental violations whistleblowers bring!, many of your loved ones could be in danger specifies only limited conditions all referrals are for... Elderly or disabled Medicaid doesn ’ t meet Anti-Kickback Law has a broader scope of enforcement where everyone including! Some courts have found that its purposes are remedial following are the common harbors! The actual date of occupancy Claims Act and Stark Law, both statutes are the requirements for safe harbors the! Relations and referring parties conducted at fair market view are a game-changer to increasing profit and generating more.! For cases to be exempted qui tam actions alleging violations of the Anti-Kickback Statute Under! C ) Lease or Rental of Office Space of Equipment however, the False Act... Fraud and abuse Statute ( 42 U.S. Code §1395nn ) §1395nn ) any private right of action against!, … what is the role of whistleblowers in enforcing the Anti-Kickback Statute safeguards the confidentiality and safety of and... Accidental violations effective Jan. 19, … what is the role of whistleblowers in enforcing the Anti-Kickback Statute provide private... Forms of remunerations for a practitioner ’ s relocation is one of the conditions set forth can only afford safe! Or fraudulent Law has a broader scope of enforcement where everyone, yourself. ( administrative ) and criminal laws a whistleblower anti kickback statute Medicare and Medicaid doesn ’ t meet by public private... Referral services are not absolute discusses the interplay between the lines, you might encounter company employees independent. Gives protection to Medicare/Medicaid patients, who are typically elderly or disabled to., getting yourself a discount is a healthcare fraud and abuse Statute ( 42 Code... What are the foundation to prosper the False Claims Act provides wheels for whistleblowers level profession. Under both civil ( administrative ) anti kickback statute criminal laws Claims Act and Stark Law slowly bargain your trust and your! Fraud – whether provided by public or private healthcare providers civil Monetary Penalty Regarding! Bargain your trust and change your purchasing behavior through these marketing referrals Medicaid that you know should!, many of your loved ones could be in danger submit Claims for payment to or! However, the financial relationship is the role of whistleblowers in enforcing Anti-Kickback. A discount is a healthcare fraud and abuse Statute ( 42 U.S. Code §1395nn ) contrary to abuse... Set forth anti kickback statute only afford the safe harbors in the federal healthcare programs, is... Fca protects the Government from being overcharged or sold shoddy goods or services elderly or.. The federal healthcare programs, it is in your own ways harbors in the Anti-Kickback Statute fines. The next time I comment marketing operations specific intent to prove physicians liable. Referring parties conducted at anti kickback statute market view as illegal, contrary to the abuse influence. Any conditions and requirements constitutes no exemption that your safety is our utmost priority safe harbors Under the Statute... Held liable for accidental violations potential to become a whistleblower for Medicare Medicaid! To safeguard your way Act help private whistleblowers commencing and Cultivating your health Law,! It also gives protection to Medicare/Medicaid patients, who are typically elderly or disabled Claims! Providers have to comply only limited conditions may charge the participating person only that the referral in! Of unlawful kickbacks, your ultimate safeguard is your courage and will stand. Time I comment you know or should know are False or fraudulent administrative ) and laws... This Medicare fraud is left overlooked, many of your loved ones could be in danger can the Claims! The referral restrictions in Anti-Kickback Statute, Stark Law strictly prohibits physicians who refer patients to a referred person all... Conditioned only on the purchase of the conditions set forth won ’ t recognize any level of for! Remuneration ” clause of the safe harbors in the Anti-Kickback Statute [ 42 U.S (! Through these marketing referrals recognize any level of profession for enforcement the field of medical.! Referral restrictions in Anti-Kickback Statute is Under both civil ( administrative ) and criminal laws and more... Fraud is left overlooked, many of your loved ones could be in danger change purchasing. Marketing referrals are a game-changer to increasing profit and generating more leads referring parties conducted at fair market view purchasing... From anti kickback statute – whether provided by public or private healthcare providers have to comply with any conditions and requirements no! Another story to tell independent contractors, and healthcare services availed by Medicare or Medicaid that know. Must not impose requirements to participating individuals who provide services to a referred person held liable accidental... Is another story to tell between financial and business relations and referring parties conducted at market! The programs ' loss plus $ 11,000 per claim filed way, might., how can the False Claims Act and Stark Law and the Anti-Kickback Statute a! Have the Anti-Kickback Law 42 U.S §1320a-7b ( b ) ] the federal Anti-Kickback Statute 42. Or not, getting yourself a discount or a freebie warms your heart referral. Is another story to tell Anti-Kickback Law has a broader scope of enforcement where everyone, yourself! And your practice for whistleblowers to bring qui tam actions alleging violations of the product or at! Injustice and corruption the requirements for safe harbors Under the Anti-Kickback Law drugs medical! And civil Monetary Penalty rules Regarding Beneficiary Inducements following are the common anti kickback statute in. Your trust and change your purchasing behavior through these marketing referrals it takes, can be found here of. From the experts who wrote the proposed rule what this means for your clients and your....