Because of the importance of fairness in medical billing, the federal government has enacted multiple laws designed to prevent corruption and penalize quid-pro-quo between medical providers, patients, or pharmaceutical companies. If you are aware of wrongdoing in the healthcare industry, a diligent whistleblower attorney may be able to help.
Under the Stark Law and anti-kickback statutes in Lexington, you could be entitled to a monetary reward for sharing critical information with the authorities. Call our firm today to learn more about the whistleblower legal process and whether you are eligible.
How Does Quid-Pro-Quo Happen?
Federal law prohibits activity that involves a doctor or nursing home facility paying kickbacks in exchange for referrals. Despite this, the practice is still commonplace. For example, nursing homes might hire physicians as medical directors or advisors with few actual duties and the understanding that they will refer any patients needing long-term care to the facility.
This behavior often does not involve directly exchanging cash for patient referrals. For example, a hospital might offer discounted office space for doctors who refer their patients to specialists within the building.
Similarly, drug companies may pay for trips or offer investment opportunities to medical professionals willing to prescribe their products. Reporting these actions could result in a monetary award for a Lexington resident through either Stark Law or the anti-kickback statutes.
What is the Stark Law?
Over the years, the federal government has determined that improper medical referrals have resulted in wasteful spending. Countless individuals rely on programs like Medicare and Medicaid, and using government money to pay inappropriate referrals is a problem Congress works to prevent.
The Stark Law explicitly forbids physicians from sending a patient to a specialist or other medical professional who has a financial relationship with the doctor. This extends beyond the medical provider and prevents anyone from making deals with their immediate relatives as well.
The consequences for a doctor who violates this law are severe. In addition to any fines they face, the government could ban them from seeking claims through Medicare or Medicaid in the future, making it impossible for them to continue practicing medicine in some cases. A whistleblower could pursue a False Claims Act lawsuit to seek compensation if a Stark Law violation results in prosecution and penalties.
Understanding Anti-Kickback Statutes
The Anti-Kickback Statute is a federal act similar to the Stark Law in Lexington. While designed to prevent self-dealing, it goes beyond applying to physicians. Any party involved in these schemes could face consequences. There is also a prohibition on filing future Medicaid and Medicare claims.
Unlike the Stark Law, this statute is criminal in nature. In addition to a $25,000 fine, there is also the potential for incarceration for up to five years. Another significant difference is the source of funding. Misuse of any government funds, not just from specific programs, can trigger anti-kickback laws.
Get in Touch With a Lexington Attorney About Stark Law and Anti-Kickback Statutes Today
Whistleblowers have an opportunity to prevent fraudulent practices and protect the public from self-dealing. With the support of a tenacious attorney, they may also be entitled to seek compensation through the False Claims Act.
If you have questions about the Stark Law and Anti-Kickback statutes in Lexington, now is the time to ask. Call today to schedule your initial private consultation.
