The federal Anti-Kickback Statute is a federal law that essentially provides that doctors can’t accept and healthcare entities (such as hospitals, pharmaceutical companies, medical suppliers, and laboratories) can’t offer remuneration – in order to obtain referrals. Medical referrals should be based on what is best for a patient and not the financial interests of the patient’s doctors.
In general, any violation of the Anti-Kickback Statute (AKS) is also considered a violation of the federal False Claims Act (FCA). The FCA allows whistleblowers to receive an award, a percentage of any recovery, if their evidence leads to a settlement or a verdict against the healthcare providers who committed misconduct. The award is based on more than just the amount of the illegal payments. The percentage is also based on treble damage penalties and statutory penalties. The FCA and AKS apply to payments made through Medicare, Medicaid, and any other federal healthcare programs such as TRICARE, a military healthcare program.
The AKS provides for civil and criminal penalties.
Illegal forms of remuneration include, according to the Office of Inspector General – Department of Health and Human Services include – “anything of value and can take many forms besides cash, such as free rent, expensive hotel stays and meals, and excessive compensation for medical directorships or consultancies.”
The AKS applies to remuneration by hospitals and health companies in the form of:
- Cash payouts
- Payment for directorships and honorariums where the doctor does no or little work to justify the fee
- Vacations, expensive lunches, and other benefits
- Almost anything of value
The AKS also applies to the doctor/patient relationship. Doctors’ cannot:
- Waive copayments as a general rule. Some waivers may be allowed for patients in financial need
- Provide discounts to patients for products, prescriptions, and other items such as medical devices
In general, the AKS does require a showing that the violation was lawful and willful.
At the California Law Offices of Stephen Danz and Associates, our whistleblower attorneys help whistleblowers understand which types of misconduct violate the Anti-Kickback Statute and the False Claims Act. To review your concerns and rights, call our firm at online contact form to schedule a free consultation.or use our