The U.S. Department of Justice enforces the Stark Law and Anti-Kickback Statute to ensure physicians and other medical providers work in the best interest of patients, not for their own financial gain. Both laws prevent medical providers from taking illegal kickbacks or bribes that would encourage them to send patients for tests, lab work, or other unnecessary services billed to government programs such as Medicare and Medicaid.

Violations of these laws have been an effective way of cheating the government. Whistleblowers have interceded to file claims against medical providers taking kickbacks or other perks and increasing the government program costs for the over-utilization of services. A whistleblower brings these claims under the False Claims Act and can benefit from a reward when prosecution is successful. A whistleblower claim attorney can best explain how the Stark Law and Anti-Kickback statutes in Greenville work.

The Federal Anti-Kickback Statute

The Anti-Kickback Statute is codified at 42 U.S.C. § 1320a-7b(b). It identifies a wide range of illegal activities that all medical providers in a position to refer patients or recommend services could engage in. Referrals encompass any medical service or item a federal program will pay for partly or entirely.

The Anti-Kickback Statute requires the element of intent on the part of those engaging in illegal activity in Greenville. Something valuable, like money, must be given knowingly and willfully to induce referrals purposely. When a provider bills Medicare or Medicare for treatment or items performed for a kickback, it amounts to a false claim under the False Claims Act.

The Federal Stark Law

The Stark Law, codified at 42 U.S.C. § 1395nn, refers only to physicians. The designated health services considered referrals under the law are limited to hospital services, lab testing, durable medical equipment, and drugs prescribed by a physician. Limited safe harbors permit some arrangements, but a wide range of financial relationships with physicians is illegal.

Additionally, Stark Law does not require that a wrongdoer intended to induce referrals. An attorney in Greenville could discern whether the information a whistleblower knows amounts to a violation of Anti-Kickback Statutes or Stark Law.

Examples of Illegal Financial Arrangements

Both the Stark Law and Anti-Kickback Statutes ask whether someone or some entity provided something valuable to induce referrals. Some examples of violations of these laws include:

  • Nursing homes that offer physicians who treat elderly patients large salaries to serve as Medical Directors, but the physicians do little to no actual work
  • Drug companies that offer physicians an investment opportunity with terms that depend on the business the physician will refer
  • Hospitals that tie physicians’ salaries or bonuses to the number of tests or procedures ordered or performed at the hospital
  • Hospitals that arrange special pricing on office space or free support staff for a physician
  • Durable Medical Equipment companies that pay nursing homes to provide their equipment exclusively at an inflated price
  • Drug companies that send pharmacists on lavish trips to switch patients’ prescriptions to their medications

Whistleblowers with information about kickbacks or any exchange of something valuable for referrals should consult a lawyer in Greenville who understands the complex Stark Law and Anti-Kickback statutes and has experience in filing qui tam claims.

Whistleblower Rewards Under Stark Law and Anti-Kickback Statutes in Greenville

Although there are similarities and differences between the Stark Law and Anti-Kickback Statute, they both essentially seek to stop people from bribing medical professionals for referrals that cost federal programs like Medicare and Medicaid millions of dollars annually.

Whistleblowers play an important role in stopping this illegal practice by filing qui tam lawsuits on behalf of the government. Whether the government takes them over or the whistleblower proceeds with the help of an attorney, they could be entitled to between 10 and 30 percent of what is recovered. To learn whether your information amounts to a Stark Law or Anti-Kickback Statute claim in Greenville, consult an experienced whistleblower attorney.

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