The Anti-Kickback Statute or AKS is a healthcare law that prohibits individuals and entities from a willful and knowing payment of “remuneration” or rewarding anything of value – such as position, property, or privileges – in exchange for patient referrals that involve payables by the Federal healthcare programs.
What is the AKS (Anti-Kickback Statute)?
What Is the Anti-Kickback Statute? What Is the Anti-Kickback Statute? The AKS prohibits transactions intended to induce or reward referrals for items or services reimbursed by the federal health care programs.
What is the law on kickbacks in healthcare?
Let's start with Number One: What does the law prohibit? Under the Federal Anti-kickback Statute you may not knowingly and willfully offer, pay, solicit or receive anything of value to induce or reward for referrals of Federal health care program business. In some industries, it is acceptable to reward those who refer business to you.
What is the difference between Stark Law and Anti Kickback Statute?
The Anti-Kickback Statute is a separate law from the Stark Law; however, the Anti-Kickback Statute may, in many instances, cover conduct within the scope of the Stark Law (and vice versa). A claim made to the federal government (e.g., a claim to Medicare for a patient visit) that results from a violation of the Anti-Kickback Statute is, ...
What are “referrals” under the Anti-Kickback Statute?
“Referrals” under the Anti-Kickback Statute include “any item or service for which payment may be made in whole or in part under a Federal health care program.” While the Anti-Kickback Statute covers a broad range of activity, it also requires a showing of an “intent to induce referrals.”
Which of the following examples is a kickback prohibited by the federal Anti-kickback law?
Examples of prohibited kickbacks include receiving financial incentives for referrals, free or very low rent for office space, or excessive compensation for medical directorships.
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 an example of an Anti-Kickback Statute AKS violation?
Anti-kickback statute examples Any offer to a physician or entity that aims to increase referral rates in exchange for something of value is considered a violation of the Anti-Kickback Law. Here are a few examples: Receiving a performance bonus tied to the number of lab tests ordered at the hospital.
Which of the following are potential violations of the US Anti-Kickback Statute?
Other forms of remuneration that could potentially violate the AKS if implicitly or explicitly exchanged for referrals include excessive "speaker fees"; paid trips and "consulting fees"; offers to fund independent research; free or below market office space or administrative services; certain profit-sharing ...
What is considered a kickback?
Kickbacks: an overview 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 is an example of a kickback in healthcare?
Examples of illegal kickbacks in healthcare can be cash payments, but often include other items of monetary value, such as gifts, free or discounted supplies or services, and travel. Hospitals and other companies often try to disguise their medical kickbacks as legitimate payments.
What is the nickname for the Anti-Kickback Statute?
The Anti-Kickback Statute is the popular name for The Medicare and Medicaid Fraud and Abuse Statute, 42 U.S.C. § 1320a-7b(b). The AKS is a federal criminal law.
What is an example of a Stark Law violation?
An example of a Stark law violation is a hospital paying doctors money to refer cardiac patients to their hospital. Similarly, it is a violation of Stark for a laboratory or outpatient clinic to pay hospitals to refer patients to them.
What is definition of referral under Anti-Kickback Statute?
The Stark Law defines “referral” as “the request by a physician for a consultation with another physician” and also “the request or establishment of a plan of care by a physician, which includes the provisions of designated health services.”92 Patel argued that Congress explicitly defined “referral”93 so broadly in the ...
What 5 elements must exist for a Stark Law violation to occur?
In order for a relationship to implicate Stark, five basic elements must be present: (1) a physician must make (2) a referral for the furnishing of (3) designated health services payable by Medicare (4) to an entity (5) with which he/she (or an immediate family member) has a financial relationship.
Which of the safe harbor conditions apply as an exemption to the federal anti-kickback regulations?
One of the recognized safe harbors to the Anti-Kickback Statute is “a discount or other reduction in price obtained by a provider of services or other entity under [Medicare or Medicaid] if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider or ...
Which of the following is not a violation of the False Claims Act?
A person does not violate the False Claims Act by submitting a false claim to the government; to violate the FCA a person must have submitted, or caused the submission of, the false claim (or made a false statement or record) with knowledge of the falsity.
Why was the anti kickback statute enacted?
The Anti-Kickback Statute (AKS) was first enacted through the Social Security Amendments of 1972 in order to combat fraud and abuse in the Medicare and Medicaid Programs.
What is the focus of the Stark law?
The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians from referring patients to receive "designated health services" payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.
What is the Anti-Kickback Statute?
The Anti-Kickback Statute or AKS is a healthcare law that prohibits individuals and entities from a willful and knowing payment of “remuneration” or rewarding anything of value – such as position, property, or privileges – in exchange for patient referrals that involve payables by the Federal healthcare programs.
What is the remuneration clause in the Anti-Kickback Statute?
As already mentioned, the “remuneration” clause of the Anti-Kickback Statute specifies only limited conditions. For your advantage when accused of AKS violation, here are the four quality standards to abide:
Is the Anti-Kickback Statute similar to Stark Law?
While these healthcare laws uphold the integrity of Medicare and Medicaid beneficiaries, you should know that they have differences and similarities between the two.
What is the role of whistleblowers in enforcing the Anti-Kickback Statute?
The Anti-Kickback Statute safeguards the confidentiality and safety of innocent and victims of unlawful kickbacks in the medical industry. Together with Stark Law, both statutes are the foundation to prosper the False Claims Act case.
What are the penalties for a kickback?
Its criminal penalties include fines up to $25,000 per violation, and up to 5 years in federal prison. As to its civil penalties, the Anti-Kickback Statute includes monetary penalties up to $50,000 per violation, ...
Is anti kickback statute absolute?
But remind yourself that the referral restrictions in Anti-Kickback Statute are not absolute. Meaning, when you are accused of violating the law, your best defense is identifying your case on whether or not it covers the Safe Harbors – or the exceptions for engaging in referral activities. The safe harbor regulations in ...
Does the Anti-Kickback Statute apply to rental agreements?
Of course, the Anti-Kickback Statute exempts the rental agreements of office spaces and equipment, provided that parties will comply with the following conditions:
What is the anti-kickback law?
The Anti-Kickback Statute (AKS) is an American federal law prohibiting financial payments or incentives for referring patients or generating federal healthcare business. The law, codified at 42 U.S. Code § 1320a–7b (b), imposes criminal and, particularly in association with the federal False Claims Act, civil liability on those that knowingly and willfully offer, solicit, receive, or pay any form of remuneration in exchange for the referral of services or products covered by any federal healthcare program (e.g., the referral of a Medicare patient for an MRI), subject to certain narrow exceptions. In other words, the statute covers both those that provide (or offer) kickbacks and those that receive (or solicit) kickbacks. The statute is among the most important healthcare fraud and abuse laws in the United States. Violation of the Anti-Kickback Statute is a felony.
What is illegal remuneration?
The illegal remuneration covered by the Anti-Kickback Statute includes "anything of value" and is therefore not limited to cash. Thus, the sorts remuneration barred by the Anti-Kickback Statute may be, for example, in the form of consulting fees, gifts (e.g., sports tickets), discounted rent, research grants, and bonuses.
Is anti kickback a felony?
Violation of the Anti-Kickback Statute is a felony. The Anti-Kickback Statute was "enacted to ensure that clinical decisions and medical services are provided to patients based on their medical needs and not on the improper financial considerations of providers.".
Is the Stark Law the same as the Anti Kickback Statute?
The Anti-Kickback Statute is a separate law from the Stark Law; however, the Anti-Kickback Statute may, in many instances, cover conduct within the scope of the Stark Law (and vice versa).
When did the AKS become a safe harbor?
Second, the legislation directed HHS to promulgate regulations that created additional exceptions to the AKS, referred to as “safe harbors.”. On July 29, 1991, the OIG issued the first in a series of regulations implementing the safe harbors. In 1996, Congress further amended the AKS through the Health Insurance Portability and Accountability Act ...
When was the AKS passed?
To combat these unethical practices, Congress passed the original version of the AKS in 1972. The statute made the receipt of kickbacks, bribes, or rebates in connection with items or services covered by the Medicare and Medicaid programs a misdemeanor punishable by a fine, imprisonment, or both.
What is AKS in health care?
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. 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 ...
What are the changes to the AKS?
HIPAA made three significant changes to the AKS: (1) extending its reach beyond Medicare and state health care programs to apply to services covered by the “federal health care programs”; (2) adding a new exception to the AKS relating to certain risk-sharing organizations; and (3) enhancing communication between the OIG and the public about the applicability of the AKS to certain transactions. Congress also directed the OIG to develop standards related to the new risk-sharing exception and to solicit proposals for new safe harbors, modifications to existing safe harbors, and fraud alerts regarding inappropriate conduct. Finally, HIPAA required the OIG to establish a procedure whereby providers could request advisory opinions regarding the applicability of the AKS or a safe harbor to a given arrangement.
When did the OIG clarify the safe harbors?
This process began in 1999 when the OIG clarified the existing 1991 safe harbors and added additional safe harbors. The preambles to these rules continue to serve as valuable sources of OIG guidance on its interpretation of the AKS and the safe harbors. This article is an excerpt, reprinted with permission, from What Is . . . ...
What is the AKS?
The federal Anti-Kickback Statute (AKS) is one of the best-known federal fraud and abuse statutes, due largely to its wide-ranging effects on business relationships in the health care, pharmaceutical, and medical device sectors.
Why did Congress add a civil monetary penalty?
By adding a civil monetary penalty (and thereby lowering the burden of proof that prosecutors had to meet to impose this civil, as opposed to criminal, sanction), Congress provided prosecutors with an additional tool to combat potential fraud.
What is the Anti-Kickback Statute?
The Anti-Kickback Statute, 42 U.S.C. § 1320a-7b (b), covers a broader range of activity than the Stark Law, and extends to all medical providers in a position to arrange or recommend medical services. “Referrals” under the Anti-Kickback Statute include “any item or service for which payment may be made in whole or in part under a Federal health ...
What are some examples of anti-kickback laws?
Classic examples of violations of Anti-kickback and Stark laws include: Hospitals, nursing homes, labs, dialysis centers, drug, or DME companies paying kickbacks to doctors through big salaries or “consulting” fees to serve as Medical Directors , proctors, or “ consultants,” where the doctors do little actual, useful work; ...
What are kickbacks in medical?
Both the Anti-Kickback Statute and the Stark Law are designed to keep medical treatment decisions free from the influence of potential monetary gain. Kickbacks and other unlawful financial arrangements give providers reasons to send patients for services they might not actually need. They can lead to: 1 Over-utilization of medical services; 2 Increased program costs for Medicare, Medicaid, and other payors; 3 Poor medical decision-making; and 4 Unfair competition.
What is the Stark Law?
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 financial relationships.
What is the purpose of the Stark Law and the Anti-Kickback Statute?
Both the Anti-Kickback Statute and the Stark Law are designed to keep medical treatment decisions free from the influence of potential monetary gain. Kickbacks and other unlawful financial arrangements give providers reasons to send patients for services they might not actually need. They can lead to:
What is the difference between the Anti-Kickback Statute and Stark Law?
There are differences between the Anti-Kickback Statute and Stark Law, and regulations provide “safe harbors” permitting certain arrangements. Significant experience with the statutes and regulations is often required to to understand, analyze, and develop a False Claims Act case based on violations of them. Typically, however, the core analysis looks at the a fundamental question: was something of value provided to induce health care referrals?
Why do providers argue that they did not know they were violating the FCA?
Therefore, providers may not argue that they did not know they were violating the FCA because they were not aware the Anti-Kickback Statute existed.
What is the anti kickback statute?
1. Congress originally enacted the Anti-Kickback Statute as part of the Social Security Amendments of 1972. Until then, only one provision sanctioned false claims and misrepresenting facts to the government, and the limited language impeded efforts to prosecute Medicare ...
How many states have anti kickback laws?
In addition to the federal Anti-Kickback Statute, approximately 36 states and the District of Columbia also have laws that prohibit paying remunerations for healthcare program business referrals, according to the National Conference of State Legislatures.
How much is the penalty for a kickback?
Criminal penalties can include fines up to $25,000 and a five-year prison term per kickback while civil penalties can cost as much as $50,000 per kickback in addition to three times the amount of damages sustained by the government.
When did the intent requirement change?
In 2010, the PPACA amended the intent requirement to clarify that the government no longer has to prove the defendant intended to violate the Anti-Kickback Statute itself, just that a defendant intended to violate the law and were paying for Medicare or Medicaid business. 11.
What is the significance of the case of United States v. Greber?
Greber in 1985 was the landmark case that established that paying referring physicians to use a laboratory's services — even if the remuneration was compensation for professional services — violated the Anti-Kickback Statute, according to the Journal of Health Law. The case also established the premise that if even one purpose of a payment made is for a referral of business, the payment is deemed to be illegal. The new ruling prohibited business transactions that were once fairly innocuous, leading to the creation of safe harbors.
When did the Medicare-Medicaid Anti-Fraud and Abuse Amendments become a felony?
In 1977 , the Medicare-Medicaid Anti-Fraud and Abuse Amendments increased the penalty for violating the statute from a misdemeanor to a felony to discourage further fraudulent activity. 3. To cut down on Medicare and Medicaid fraud and abuse, including Anti-Kickback violations, HHS and the Department of Justice also created ...
Can a violator of the Anti-Kickback Statute be excluded from federal healthcare?
Violators can also be excluded from federal healthcare programs. 5. The government contends that violating the Anti-Kickback Statute exploits the healthcare system, drives up program costs and hinders fair competition in the industry.
What is the anti kickback statute?
In the medical field, the Anti-Kickback Statute (AKS) (42 U.S.C. § 1320a-7b (b)) prohibits any provider or entity from “willingly and knowingly” giving or receiving money, services, or things in exchange for patient referrals or purchasing goods and services. These can be as subtle as accepting or offering free items, cash, gift cards, and event tickets in exchange for purchasing or selling their products.
Why did the federal government institute the Anti-Kickback Statute and Stark Law?
The federal government instituted the Anti-Kickback Statute and Stark Law in an effort to eliminate healthcare fraud and abuse. Simply stated, both regulatory laws prohibit medical providers and/or entities from making health service referrals in exchange for compensation of any kind.
What is the difference between Stark and Anti-Kickback?
The Stark Law and the Anti-Kickback Law are very similar with a few key differences. 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 the Stark Law?
§ 1395nn), originally named the Patient Referrals Act, prohibits a physician from referring Medicare or Medicaid patients to an entity with which the physician or immediate family member has a financial relationship. These Designated Health Services include:
What are the penalties for the Stark Law?
The penalties for The Anti-Kickback Statute and Stark Law can be hefty and may result in everything from steep fines to jail time and even the loss of your medical license. Don’t battle it alone. A healthcare fraud defense attorney can:
What to do if you are suspected of a kickback?
We use an aggressive, client-focused, team approach to help you decrease, and potentially avoid, any severe fines, loss of your practice or medical license, withheld reimbursements, or jail time.
What is a kickback?
In terms of the law, a “kickback” refers to the misuse of funds that benefits a person with power or influence to help make another person/organization richer. Kickbacks can come in different forms including money, products, gifts, credit, or anything of value.
Anti-Kickback Statute (AKS) Explained
What Is The Anti-Kickback Statute (AKS)?
- The Anti-Kickback Statute (AKS) is defined as an anti-corruption statute that prohibits financial transactions that reward referrals for products and services reimbursed by healthcare programs sponsored by the federal government of the U.S. According to the American Bar Association, this criminal statute was created to protect the beneficiaries of ...
What Exactly Does The Anti-Kickback Statute (AKS) prohibit?
- The Anti-Kickback Statute (AKS) prohibits people, organizations, and companies from intentionally making, receiving, offering, or soliciting financial payments in exchange for the following: 1. Making a referral for a person towards another individual or organization for the provision of a service or item that a federal healthcare program may reimburse 2. Making a reco…