Atlanta Kickbacks for Referrals Attorney
The federal government has made kickbacks for referrals illegal because they create incentives for using medical services which are unnecessary. A kickback is essentially any payment or thing of value offered or received in exchange for a referral for medical services. Two laws typically come into play, the Anti-Kickback Statute and the Stark Law.
At Stacey Evans Law, we help whistleblowers fight government fraud. Contact our law firm today to find out what protections are available for blowing the whistle.
Why the Government Fights Kickbacks
Referrals might sound like an ordinary part of doing business. And, in fact, many businesses rely on referrals to generate clients. But the federal government has tried to eliminate them when they result in the use of government programs like Medicaid or Medicare.
Referrals can increase the odds of:
- Wasting government resources for unnecessary care
- Burdening the health care system with patients who are not really sick
- Increasing the costs of care
- Encouraging unfair competition between medical providers
- Leading to poor health outcomes
The Anti-Kickback Statute
This law is found at 42 U.S.C. § 1320a-7b and prohibits the offer or acceptance of “remuneration” in exchange for referrals for services paid by federal health care programs. We see this statute come into play in a variety of situations involving:
- Doctors
- Hospitals
- Medical device manufacturers
- Pharmaceutical companies
- Nursing homes
- Hospice programs
- Home healthcare programs
- Ambulance companies
For example, a nursing home might offer payments to hospitals that refer Medicare patients to them. Similarly, a medical device manufacturer or pharmaceutical company might offer deeply discounted items to encourage the doctor to use them, and the doctor bills Medicare or Medicaid.
Offering to waive Medicare copays can also qualify as a kickback since it could possibly induce a patient to use medical services he otherwise wouldn’t. In fact, this is a very broad law, and it is no defense for a defendant to claim he or she would have ordered specific treatment regardless of the kickback.
The Stark Law
This law is also called the Physician Self-Referral Law. It prohibits doctors from referring patients for certain “designated health services” paid by Medicare/Medicaid to entities which the doctor or a close family member has a financial interest in.
Designated health services include clinical lab services, physical therapy, radiology services, home health services, and outpatient prescription drugs, among others. You can find the full list at 42 U.S.C. § 1395nn.
For example, a doctor cannot refer a patient to a physical rehabilitation practice which she co-owns. She also cannot refer a patient for clinical lab work to a clinic which her spouse partly owns. These types of self-referrals are illegal. Strict liability applies—meaning, the government does not need to show any intent to defraud. The violation itself is enough for liability.
Contact Our Atlanta Anti-Kickback Attorney Today
Violations of the Anti-Kickback Statute and the Stark Law can result in false claims to the government. Under the False Claims Act, someone with information about fraud can bring a civil suit on the government’s behalf for triple the amount of money defrauded, plus civil fines.
Stacey Evans Law can help those with information about illegal kickbacks pursue these claims. Contact us today to learn more.
