According to the Federal Anti-Kickback Statute, it is a felony to offer or receive remuneration to gain reimbursable business under any federal program.
If you violate the Anti-Kickback Statue you can potentially face legal and disciplinary actions. To be charged with violating the Anti-Kickback Statute, you must participate in remuneration as well as illegal or ill intent.
How Is An Anti-Kickback Case Proved?
First, there must be evidence and proof of remuneration between the accused parties. With remuneration, bad intentions also have to be proved. There does not have to be a specific intent, just bad intentions in general.
What is Remuneration?
Anything that has value can be considered remuneration. Cash, donates, consulting fees, and gifts are a few examples of remuneration. The Anti-Kickback Statute is violated f any compensation or monetized award is offered between two parties participating in a government health program.
The Anti-Kickback Statute is broad. You do not have to violate a specific offense to be at fault. The statute is so broad, that a simple payment arrangement for referrals violates the U.S. v. Greber, 760 F.2d 68 (3rd Cir. 1985).
In general, any form of financial benefit or payment is given to a physician is remuneration. If this occurs, a physician must prove to the federal government the intentions behind the act of remuneration.
What Are The Intent Requirements For Anti-Kickback Violations?
If a physician or healthcare facility recommends the purchase, ordering, or leasing of any good, this qualifies as an illegal intention. Also, any reward for referrals or services is an illegal intention if participating in a government healthcare program.
There is a new Patient Protection and Affordable Care Act (PPACA) that was passed in 2012. According to this act, a defendant’s knowledge of the Anti-Kickback Statute is not required to prove guilt. Therefore, someone cannot claim that they were unaware of the policies and actions that were taking place. This specific clause is found in the 42 U.S.C, 1320a-7b(h).
The PPACA reduces the intent standard for the government to prove violations against the Anti-Kickback Statute. Since it is now easier to prove guilt, parties must make it very clear that all of their intentions in healthcare are good.
If someone has any knowledge or awareness of a violation, he/she can be held responsible.
Anti-Kickback Violation Charges
Are anti-kickback violation charges criminal or civil? A civil charge results in the government requiring monetary payback. In a criminal charge, a prison term is required.
Healthcare fraud crimes can fall under both civil and criminal. Every year there are approximately 1,400 people accused of healthcare fraud. Also, there are almost 3,000 people each year that face Medicare investigation.
Whether an anti-kickback case is a civil or criminal crime depends on the specific actions performed and the type of remuneration. Each case varies. An anti-kickback defense attorney can better help you with determining how the government can potentially handle your case.
Anti-Kickback Violation Investigation
Anyone involved in the healthcare system can be subject to violation of the Anti-Kickback Statute. Although physicians, practitioners, nurses, health care businesses, and more are subject to legal action, some areas are under more scrutiny.
Particularly, the following industries are often under investigation:
• Physician-owned companies
• Medical device companies
• Imaging centers
• Surgery centers
The government places scrutiny on the above industries to enforce the regelation of the Anti-Kickback Statute. When more scrutiny is placed, the more likely people will follow the necessary guidelines and policies.
Avoiding Government Scrutiny
The number one defense against anti-kickback charges is to seek counsel from an attorney. Receiving the advice from an experienced anti-kickback defense lawyer will help guide you in questionable dealings and arrangements. To avoid charges, consult with your lawyer to discuss the details of your healthcare program relationships and partnerships.
If you have any healthcare program relations, it is best to have a lawyer to guide the business. Meeting requirements and abiding by policies can help you avoid government scrutiny.
Another way to avoid scrutiny is to participate in a safe harbor arrangement. Safe harbors are arrangements that appear to go against anti-kickback regulations, but they are exempt from being sanctioned. Safe harbor arrangements do not violate the Anti-Kickback Statute. A safe harbor is considered goo intent.
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