What is a referral under the anti-kickback statute?

The federal Anti-Kickback Statute (AKS) (See 42 U.S.C. § 1320a-7b.) is a criminal statute that prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of business reimbursable by federal health care programs.

What is an example of the anti-kickback statute?

Basically, anything of value to a person in a position to refer, such as cheap office space, patients referrals, a free employee, or a fat bonus, can classify as an illegal inducement under the Anti-Kickback and Stark laws.

What is the difference between the Stark Law and the anti-kickback statute?

The Anti-Kickback Law covers referrals for all services from anyone including physicians or pharmaceutical companies. Conversely, the Stark Law is for referrals from physicians only and covers a set list of “Designated Health Services” (DHS).

What is prohibited by the anti-kickback statute?

The AKS is a criminal law that prohibits the knowing and willful payment of “remuneration” to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients).

What is Stark I and Stark II?

There are two components to the Stark statute. Stark I deals with clinical laboratory services, and Stark II, which came out in 1995, extended the reach of the prohibition to 11 categories of designated health care services.

Who enforces Anti-Kickback Statute?

The Department of Justice (DOJ)
The Department of Justice (DOJ) enforces the criminal penalties of the AKS. The criminal penalties include fines of up to $100,000 and ten-years’ imprisonment. Violations of the AKS may also result in civil penalties.

What is an example of a kickback in healthcare?

Hospitals and other companies often try to disguise their medical kickbacks as legitimate payments. For example, they might pay doctors inflated rates for speaking engagements or pay above fair market value to lease office space.

Is Stark Law voluntary?

The Stark Law has mandatory exceptions, such as the Fair Market Compensation Exception or the In-Office Ancillary Services Exception, and the AKS only has voluntary safe harbors that can protect certain payment and business practices that would otherwise violate the law.

What is an anti-kickback policy?

The Anti-Kickback Statute The federal Anti-Kickback Statute prohibits knowingly and willfully offering, paying, soliciting or receiving anything of value as an inducement or reward to refer items or services for which payment is available under the federal or state healthcare programs, such as Medicare and Medicaid.

What is DHS under Stark?

The Stark Law (“Stark”) is a federal self-referral law that bans physicians from referring certain services that are reimbursable by Medicare or Medicaid, referred to as designated health services (“DHS”), to entities that the physicians or their immediate family members have a financial relationship with.

What is the Stark 2 law?

Stark II: Physician self-referral More specifically, the Stark Law prohibited a physician from making referrals for certain designated health services payable by Medicare to an entity with which they have a financial relationship.