A significant portion of the American healthcare industry accepts patients with Medicare or Medicaid. When doctors or health facilities take on these patients, they understand that the federal government will be paying a portion of or all the costs associated with the treatment. Because of this, the federal government has a profound interest in combating corruption and waste.
One example of a way in which Congress has acted to prevent these abuses is the passage of the Stark law. This law prohibits doctors and other medical professionals from referring patients under Medicare or Medicaid to other providers with whom they have a financial relationship. The goal of this law and other related anti-kickback statutes is to prevent unnecessary treatment and the taking advantage of federal healthcare programs.
Similarly, the Anti-Kickback Statute (AKS) criminalizes the payments of remuneration to parties who refer patients to a business while payment would come about from the federal healthcare system. A Columbia lawyer could help you to better understand these laws and how they impact the healthcare profession.
Most senior citizens and people with permanent disabilities received subsidized healthcare through the Medicare or Medicaid programs. As such, the federal government often pays a significant portion of their healthcare costs. Medical providers who treat these patients then submit claims for payment to the government.
Sadly, instances of misappropriation and improper referrals cause a significant degree of waste in these programs. In response, Congress passed the Stark Act, codified in 42 United States Code § 1395nn. This statute prohibits physicians from making referrals for services payable by Medicare or Medicaid to another provider with which they have a financial relationship. This prohibition also extends to immediate relatives of the physician who may have a financial stake.
Physicians who violate this law can face harsh financial penalties as well as exclusion from making future Medicare or Medicaid claims for payment. An attorney in Columbia could provide more information about the Stark law and its impact on healthcare billing and referrals.
A law similar to the Stark law that aims to limit corruption in the healthcare industry is the Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b). Unlike the Stark law, where a violation can result in administrative penalties, the Anti-Kickback Statute provides for criminal penalties. This means that a doctor or other healthcare provider who violates this law is guilty of a felony that can justify a prison term of up to ten years, a fine of up to $100,000, or both.
This statute prohibits the improper referrals of patients who receive medical care through Medicare or Medicaid. In short, it is illegal for any healthcare provider to offer remuneration or payment to another party in exchange for a patient referral when that patient is a member of a federal healthcare program. Just as doctors may face penalties for violating this law, so too may the entities providing the referrals. A Columbia attorney could help parties to better understand the Anti-Kickback Statute and how it regulates the healthcare industry.
Medicare, Medicaid, and other federal healthcare programs provide funds to a substantial proportion of healthcare providers in the Columbia area. However, medical providers must follow strict rules when taking on these patients. This is especially important when receiving referrals or sending out patients to specialists.
The Stark law prohibits sending out patients to other providers when the referring doctor has a financial stake in the other entity. This even extends to members of the doctor’s family. Similarly, the Anti-Kickback Statute does not allow for payments to any party for referrals toward patients on federal healthcare plans. This is a criminal act where a conviction can have severe consequences. Reach out to a Columbia lawyer today to discover more about the referral laws that regulate the healthcare industry at the federal level.