The Anti-Kickback Statute

Posted on Jun 24, 2019 in Billing, Medicare Fraud

A Criminal Law

The Anti-Kickback Statute is a criminal law that prohibits the knowing and willful payment or “remuneration” to induce or reward patient referrals.  It also applies to  the generation of business involving any item or service payable by the Federal health care programs. Remuneration includes 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. Learn more.

Penalties

Criminal penalties and administrative sanctions for violating the Anti-Kickback Statute include fines, jail terms, and exclusion from participation in the Federal health care programs. Under this law, physicians who pay or accept kickbacksalso face penalties of up to $50,000 per kickback plus three times the amount of the remuneration.

Target for Kickbacks

As a physician, you are an attractive target for kickback schemes because you can be a source of referrals for fellow physicians or other health care providers and suppliers. You decide what drugs your patients use, which specialists they see, and what health care services and supplies they receive. Many companies will attempt to take advantage of this relationship. They will attempt to pay you for the referrals.

Moreover, just as it is illegal for you to take money from providers and suppliers in return for the referral of your Medicare and Medicaid patients, it is illegal for you to pay others to refer their Medicare and Medicaid patients to you.

In addition, Medicare and Medicaid programs require patients to pay copays for services and you are required to collect them. Waiving these copays could implicate the Anti-Kickback Statute. Of course it is OK to waive if the patient cannot afford or if you have made efforts to collect.

Contact us for more information on these important topics and anesthesia compliance training for you and your company.

False Claims Act and Anesthesia

Posted on Jun 5, 2019 in Billing, Compliance

An Important Law

The Federal False Claims Act and anesthesia is a topic worth considering. Of note, there are many federal laws in place that govern Medicare fraud and abuse. One of the most important laws that addresses fraud is the Federal False Claims Act.    Most importantly, it allows private citizens to bring civil actions on behalf of the United States.

The False Claims Act protects the Federal Government from overcharging or selling substandard goods or services. Consequently it imposes civil liability on any person who knowingly submits, or causes the submission of, a false or fraudulent claim to the Federal Government. Of interest, this is a law that dates back to the Civil War era.

Knowledge of Wrongdoing

The terms “knowing” and “knowingly” mean a person has actual knowledge of the information or acts in deliberate ignorance or reckless disregard of the truth or falsity of the information related to the claim. Furthermore, to violate the False Claims Act does not require proof of specific intent to defraud.

Qui Tam Complaint

The qui tam provision allows a person to file a qui tam action. Initially the government seals the qui tam complaint 60 days. Secondly, during this time the government will investigate the allegations and decide if it is proceeding with the action. Eventually if convinced by the case the government will prosecute. Finally, the individual who initially brought the case may receive between 15 and 25 percent of the amount recovered by the government.

Lack of Compliance Plan

Of importance is that the lack of a compliance plan increases the threat of Qui tam lawsuits.  Indeed this act provides significant financial incentives for private citizens to come forward as whistleblowers.

In short, the Federal False Claims Act and anesthesia is a topic that cannot be taken lightly.  Anesthesia providers should be prepared with an active compliance plan.

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