Stark Law/Anti-Kickbacks And Self-Referrals: What Every Health Care Provider Should Know

Federal law takes a strong stance against illegal kickbacks and self-referrals in the health care industry. Violations can result in steep financial penalties, exclusion from Medicare/Medicaid and even a federal prison sentence.

At Roberts Law Group, we provide a strong and dedicated defense against these allegations. We offer strategic legal services for physicians, clinics, hospitals, group practices and other health care providers.

Whether you're facing federal charges for Stark Law violations, are under investigation or on the verge of a Medicare audit, we can stand between you and the might of the federal government. Let our seasoned defense attorneys level the playing field.

Violations Of The Physician Self-Referral Law (Stark Law)

Under federal law, physicians can't refer certain services that are payable by Medicare/Medicaid to entities in which they (or a family member) have an interest, with limited exceptions. Put simply, this law is designed to prevent doctors from self-referring patients for their own financial gain (and at the expense of public funds).

Far too many unknowing physicians get swept up in the net of this statute, however. It imposes strict liability - meaning it doesn't matter whether you intended to violate the law or knew you were doing so.

And violations can be costly. Each instance can result in civil monetary penalties of up to $15,000 plus three times the amount received. Additionally, violations can land you on the exclusion list, meaning you won't be able to bill Medicare/Medicaid or other government health care programs.

Violations Of The Anti-Kickback Statute

Federal anti-kickback laws makes it a crime for providers to receive kickbacks in exchange for referrals of services covered by Medicare, Medicaid or other government health programs. With a few exceptions, providers can't receive or solicit remuneration in exchange for referrals. It's a broad constraint covering not only payments, but also financial relationships involving an exchanging of anything else of value - vacations, meals, gifts and the like. Kickbacks also include disguised payments such as inflated rents. And payments are considered kickbacks so long as one of their purposes is to secure referrals, regardless of whether they also cover legitimate services.

Providers who pay, receive or solicit kickbacks can all be charged for knowing and willful violations.

Whereas the Stark Law is a civil statute, the federal anti-kickback law establishes a serious criminal prohibition. It's a felony offense that carries harsh criminal penalties - including a potential federal prison sentence of up to five years. Defendants also face fines of up to $25,000 and civil monetary penalties of up to $50,000 plus three times the amount of the kickback.

These violations also frequently overlap with the False Claims Act and fraudulent billing charges. When mishandled, the criminal charges can quickly multiply. Our lawyers can help stem the tide by pursuing an aggressive and strategic defense.

It's Not Always Straightforward

With the complexity of many corporate structures in the health care field, it's easy to run afoul of the Anti-Kickback Statute. The federal Office of the Inspector General (OIG) encourages organizations to seek advisory opinions in unclear cases. It's far better to identify potential issues before they escalate to a federal investigation or grand jury indictment - especially when considering service agreements or financial arrangements that could expose you to civil or criminal liability.

Our attorneys can help health care organizations both large and small avoid these serious law violations by conducting a thorough compliance review of matters such as compensation arrangements, billing practices, payments and other areas of concern. We can also assist you with securing an OIG opinion if needed. When it comes to such high-stakes matter - and such murky areas of law - erring on the side of caution can pay dividends down the road.

Learn More

You can turn to our legal team for guidance on any aspect of the Stark Law, the Anti-Kickback Statute, the False Claims Act or other health care regulations. Learn more about enlisting our attorneys to protect your business, reputation, licensure and future. Call 866-630-2389 or send us an email to get started.