What is an example of the Anti-Kickback Statute?
What is an example of the Anti-Kickback Statute?
Drug companies paying kickbacks to pharmacies (retail or specialty) to get them to switch patients’ prescriptions; Drug companies paying kickbacks to insurers to get on their formularies; Payments by specialty pharmacies, DME suppliers, therapy centers, nursing homes, etc. to patient recruiters or to patients directly.
How does the Anti-Kickback Statute differ from the Stark law?
Source of Prohibited Referrals: Whereas the Stark Law is only concerned with referrals from physicians, the Anti-Kickback Statute applies to referrals from anyone. A violation of the Anti-Kickback Statute constitutes a federal felony punishable by up to 5 years in prison and up to a $25,000 fine for each violation.
Which is an example of a Stark law violation?
For example, if you invest in an imaging center, the Stark law requires the resulting financial relationship to fit within an exception or you may not refer patients to the facility and the entity may not bill for the referred imaging services.
What is stark anti-Kickback?
The Stark law prohibits physicians from referring patients to receive certain designated health services (DHS) payable by Medicare from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.
What is considered a kickback?
A “kickback” is a term used to refer to a misappropriation of funds that enriches a person of power or influence who uses the power or influence to make a different individual, organization, or company richer. Often, kickbacks result from a corrupt bidding scheme.
What does qui tam relator mean?
Definition. In a qui tam action, a private party called a relator brings an action on the government’s behalf. The government, not the relator, is considered the real plaintiff. If the government succeeds, the relator receives a share of the award. Also called a popular action.
What are the goals of the Anti-Kickback Statute?
At its heart, it is an anti-corruption statute designed to protect federal health care program beneficiaries from the influence of money on referral decisions and thus is intended to guard against overutilization, increased costs, and poor quality services.
What are some examples of conflicts of interest in healthcare?
For example, a doctor who is involved in developing a new medical device may receive payment from the medical device company, or a doctor who has invested in a treatment center may profit when people go there for treatments.
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 . At a minimum, documentation must .
What is a kickback and give an example?
The definition of a kickback is slang for a bribe or incentive paid to someone who helped you make money, or a sudden, forceful recoil. When you bid on a job and job is awarded to you and you have to pay someone $1000 because your received the award, this $1000 payment is an example of a kickback.
What is a violation of Stark Law?
The Stark Law is a strict liability statute. A violation is a violation, whether intentional, negligent, or inadvertent. While the Stark Law is not a criminal statute, providers who violate it face civil penalties of up to $23,863 per violation and exclusion from participating in federal health care programs.
What is the definition of Stark Law?
Stark Law. What is the Stark Law? The Stark Law is a limitation on certain physician referrals. It prohibits physician referrals of designated health services (“DHS”) for Medicare and Medicaid patients if the physician (or an immediate family member) has a financial relationship with that entity.
What is Stark Law Compliance?
Stark Law compliance is one of the pre-conditions to submission of a bill for payment to Medicare. The government takes the position, a physician is required to certify that he has read, understood, and complied with Stark Law as a condition to admission to the program.
What is a stark statute?
The Stark Statute. Another law, called the Stark Statute, regulates the financial relationship that a physician or other provider can have with companies that sell healthcare items or services. When doctors or other healthcare providers benefit financially from referring patients to a particular hospital or testing center,…