ANTI-KICKBACK COMPLIANCE
SPIN Compliance Solutions is the premier hands-on HIPAA, MACRA/MIPS, OSHA, Stark Law, and Anti-Kickback Statute Compliance Training Company serving medical practices in the continental US. We have been passionately saving physicians from compliance penalties since 2018. Our mission is simple... Take the time and frustration out of keeping your practice compliant so you can focus on your patients and practice.
If you want to take the frustration out of keeping your practice compliant then you won’t find an easier solution. Our hands-on compliance training and security audits provided by our exceptionally trained staff make it possible for you to focus on your practice. Contact us now so we can take the headache out of keeping you compliant today.
WHAT IS ANTI-KICKBACK COMPLIANCE?
The federal Anti-Kickback law, found at 42 U.S.C. § 1320a-7b(b), is a criminal statute that prohibits the offering, paying, seeking, or receiving of anything of value to induce or reward referrals, or to generate federal health care program business. The Anti-Kickback law is a criminal statute that is broadly defined and establishes penalties for individuals and entities on both sides of the prohibited transaction.
PHYSICIANS ARE ATTRACTIVE TARGETS FOR KICKBACK SCHEMES
Physicians are an attractive target for kickback schemes because they can be a source of referrals for fellow physicians or other health care providers and suppliers. Physicians decide what drugs patients use, which specialists they see, and what health care services and supplies they receive.
Many people and companies want a medical practice’s patient’s business and would pay to obtain that business. Just as it is illegal for Physicians to take money from providers and suppliers in return for the referral of their Medicare and Medicaid patients, it is illegal for Physicians to pay others to refer their Medicare and Medicaid patients to them.
We specialize in HIPAA, MIPS, OSHA, Medicare/Medicaid Audits, and more. View our services and see how we can help your medical practice today.
Our program offers cost-effective solutions to organizations so you can avoid HIPAA audits and monetary fines. Call Us Today!
Providing The Best Hands-On Anti-Kickback Compliance Training Programs To Medical Practices in St. Louis, MO., Atlanta, GA., Houston, TX., Philadelphia, PA., Hershey, PA., Oklahoma City, OK., Reno, NV., Orlando, FL., Detroit, MI., Orange County, CA and the continental United States.
Kickbacks in health care can lead to…
- Overutilization
- Increased program costs
- Corruption of medical decision making
- Patient steering
- Unfair competition
The kickback prohibition applies to all sources of referrals, even patients. For example, where the Medicare and Medicaid programs require patients to pay copays for services, Physicians are generally required to collect that money from their patients. Routinely waiving these copays could implicate the AKS and physicians may not advertise that they will forgive copayments. However, physicians are free to waive a copayment if they make an individual determination that the patient cannot afford to pay or if the practice’s reasonable collection efforts fail. It is also legal to provide free or discounted services to uninsured people.
ANTI-KICKBACK LAW PROHIBITED REFERRALS
The Anti-Kickback law is a criminal statute that prohibits the knowing and willful offer, or payment of, and the knowing solicitation or receipt of “any remuneration directly, or indirectly, overtly or covertly, in cash or in kind,” to induce:
1. referrals of patients
2. the purchasing, leasing, ordering, or arranging for any good, facility, service or item paid for by a federal health care program (including Medicare and Medicaid).
While the Anti-Kickback law requires a knowing and willful violation of the law to establish liability, with the passage of the Patient Protection and Affordable Care Act, the Anti-Kickback law was amended to make clear that actual knowledge of an Anti-Kickback violation or the specific intent to commit a violation of the Anti-Kickback law is not required for conviction. Although the government is no longer required to prove that a defendant intended to violate the Ant-Kickback law itself, it must still prove that a criminal defendant intended to violate the law.
FAILURE TO FULLY COMPLY WITH ANTI-KICKBACK
If physicians fail to fully comply with Anti-kickback, the physician, their staff, and their office can all be subject to huge fines and even criminal penalties. No physician, or medical practice, can afford to try and comply with this law on their own. It is imperative that they seek legal advice and counsel on any financial agreement.
POTENTIAL PENALTIES
Anti-Kickback law violations can subject a violator to criminal, civil, and administrative penalties. The Anti-Kickback law establishes that a violation of the law is a felony and can be punished by up to five years in prison and a fine of $25,000 per violation. Further, violators can be assessed civil monetary penalties of up to $50,000 per violation and face an additional civil assessment of up to three times the amount of the kickback received.
In addition, Anti-Kickback law violations can result in the Secretary of Health and Human Services excluding a violator from acting as a participating provider in a federal health care program. The effect of such an exclusion is that a provider can no longer receive payment for services from any federal health care program (including Medicare, Medicaid, and Tricare, among others) for services rendered. The Anti-Kickback law provides for mandatory exclusion if a violator is criminally convicted. Even negligent violations, which would not amount to criminal liability, can still result in a provider’s exclusion at the discretion of the Secretary.
ANTI-KICKBACK LAW SAFE HARBORS
Due to the potential broad reach of the Anti-Kickback law into numerous transactions, the Office of Inspector General (OIG) of the United States Department of Health and Human Services has been granted authority to promulgate regulations, which exclude certain specific business and financial practices from criminal and civil prosecution under the act. These exclusions, known as “safe harbors,” are found at 42 C.F.R. § 1001.952.
For example, Anti-Kickback safe harbor transactions include, in part:
1. investment interests
2. space rental
3. equipment rental
4. personal services and management contracts
5. referral services
6. payments to bona fide employees
7. physician recruitment efforts.
However, each safe harbor imposes precise and lengthy conditions for compliance for a transaction to fall within its scope. Thus, practitioners must evaluate each such transaction to ensure compliance. Transactions which are neither specifically excluded, nor covered under a safe harbor regulation are not violations of the Anti-Kickback law per se. Instead, OIG evaluates such transactions on a case-by-case basis. In addition, parties who are uncertain whether their arrangements qualify for a safe harbor can request an advisory opinion from OIG.