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 an exception to the anti referral law?

Physician services that are furnished (i) personally by another physician who is a member of the referring physician’s group practice or (ii) under the supervision of another physician who is a member of the referring physician’s group practice are exempt for the self-referral prohibition.

What regulation prohibits referrals from someone who has a direct or indirect financial relationship with Envision?

42 CFR § 411.353 – Prohibition on certain referrals by physicians and limitations on billing.

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 are examples of kickbacks?

Kickback Examples

  • Gifts. Any gift of above nominal value, including things such as food, event tickets, and gift cards, is an improper kickback.
  • Bribes.
  • Over Billing.
  • Diverting business to vendors.
  • Using payments or compensation to refer patient.
  • Conflict of Interest.

What is considered an illegal provider relationship?

Which of the following is considered to be an illegal provider relationship? Any person or entity who knows, or should have known, of the presentation of a false or fraudulent claim to the government for payment or approval is subject to .

What are exceptions under the Stark Law?

For example, the following exceptions to the Stark Law require a written, signed agreement: office space and equipment rental, personal service arrangements, physician recruitment arrangements, group practice arrangements, and fair market value compensation arrangements. 42 C.F.R. 411.357.

What is referral and authorization?

Utilizing our referral and pre-authorization services confirms that the patient is approved for the planned service or procedure prior to arrival, ensuring that the first stage of the revenue cycle is completed accurately. Doing so sets the rest of the claims process up for success.

What are the designated health services defined by stark?

The Stark law only applies to “designated health services,” which include many of the ancillary services family physicians provide, such as clinical laboratory services, outpatient prescription drug services and physical and occupational therapy and imaging services (e.g., MRI, CT, ultrasound).

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.