Is The Anti Kickback Statute Civil Or Criminal?

Who does the Anti Kickback Statute apply to?

The Anti-Kickback Statute and Stark Law prohibit medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients who will receive treatment paid for by government healthcare programs such as Medicare and Medicaid, and from entering into certain kinds of ….

Does Anti Kickback Statute apply to private insurance?

Currently, the Anti-Kickback Statute (“Federal AKS”) only applies to Federal health care programs. The first entity might be for Federal health care business (Medicare and Medicaid) while the second entity might be for private pay health care business (commercial insurance and cash). …

How does the Stark law impact physicians?

The Stark Law, also known as the physician self-referral law, prohibits a physician from referring Medicare or Medicaid patients for certain designated health services in which that physician (or the physician’s family member) maintains a financial interest.

What is the Stark II law?

Stark II prohibits a physician or immediate family member who has a direct or indirect financial relationship with an entity from making referrals to that entity to provide designated health services (DHS) payable by Medicare or Medicaid, unless an exception applies.

Does Stark law only apply to physicians?

The Stark statute applies only to physicians who refer Medicare and Medicaid patients for designated health services to entities with which they (or an immediate family member) have a financial relationship. There are almost 20 exceptions to the Stark statute.

What is the difference between the Stark Law and the Anti Kickback Statute?

The AKS prohibits referrals for any kind of item or service where a kickback is involved, while the Stark Law prohibits only the referral of designated health services where a financial interest is involved.

What is an illegal provider relationship?

The Stark law prohibits a physician with a financial relationship in an entity from making a referral for designated health services covered by Medicare and Medicaid to that entity even if the services are billed to an individual or other third party payer.

What does remuneration mean under the Anti Kickback Statute?

Remuneration Under the AKS Means Anything of Value, Regardless of Its Form. Remuneration is not limited to cash, credit arrangements, gifts, supplies, equipment, excessive rent payment or tangible items.

What is an example of a violation of the Anti Kickback Statute?

Several healthcare providers have violated the Anti-Kickback Statute by offering investment interests, excessive compensation, or space and equipment deals to physicians that is designed to encourage the physician to refer patients or utilize a specific facility or healthcare services.

What is the purpose of the Anti Kickback Statute?

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.

What is considered a kickback?

A kickback is an illegal payment intended as compensation for preferential treatment or any other type of improper services received. The kickback may be money, a gift, credit, or anything of value. … Kickbacks are often referred to as a type of bribery.

What is considered a kickback in healthcare?

Kickbacks are arrangements made between providers in which one party refers patients to another through services, goods or medicines. … In this hypothetical, the physician is giving out medicine not to treat their patient’s condition, but because they are receiving payments from the company that makes the drug.

What is the beneficiary inducement statute?

The beneficiary-inducement statute prohibits providing free or discounted items or services to a Medicare or Medicaid beneficiary that are apt to influence the beneficiary to seek such reimbursable services from a particular provider.

What is the penalty for violating the Anti Kickback Statute?

Criminal penalties and administrative sanctions for violating the AKS include fines, jail terms, and exclusion from participation in the Federal health care programs. Under the CMPL, physicians who pay or accept kickbacks also face penalties of up to $50,000 per kickback plus three times the amount of the remuneration.

Who does the Stark law protect?

The Stark law prohibits a physician’s referral for certain designated healthcare services (DHS) to an entity if the physician (or a member of the physician’s immediate family) has a financial relationship with the entity, unless the referral is protected by one or more exceptions provided in the law.