The Federal Anti-Kickback Statute

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In the United States, healthcare fraud and abuse are significant factor associated with increasing health care costs. It is estimated that federal government spends billions of dollars on the health care cost (Edwards & DeHaven, 2009). Despite the seriousness of fraud and abuse offenses, increasing numbers of healthcare providers are seeking new and more profitable ways to build business relationships. These relationships include hospital mergers, hospital-physician joint ventures, and different types of hospital-affiliated physician networks to cover the rising cost of health care (Showalter, 2007, p 111-114). When these types of arrangements are made, legal issues surrounding the relationship often raise. There are five important Federal fraud and abuse laws that apply to the relationship and to physicians are the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the Physician Self-Referral Law (Stark law), the Exclusion Authorities, and the Civil Monetary Penalties Law (CMPL) and (Office of Inspector General (OIG), 2010). Out of five most important laws that apply to the relationship and the physicians, we are going to focus on the Anti-Kickback Statute (AKS) and the Physician Self-Referral Law (Stark law). What is Anti-Kickback Statute and Self-Referral law? The Federal Anti-Kickback Statute is a criminal statute that prohibits any person or business entity from making or accepting payment of any type of compensation to increase referrals for health services that are reimbursable by the federally-funded health care program including Medicare and Medicaid. Since the anti-kickback statute is a criminal statute, violations of it are considered felonies, with criminal penalties of up to $25,000 in fines and fi... ... middle of paper ... ... Fraud and Abuse in Federal Programs Retrieved from Cato Institute website http://www.downsizinggovernment.org/fraud-and- abuse Office of Inspector General. (2010). A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse. Retrieved from DHHS Publication http://oig.hhs.gov/compliance/physician-education/index.asp Oh, J. (2011). Anti-Kickback Cases Involving Hospitals in 2010 and 2011. Becker’s ASC Review. Retrieved from http://www.beckersasc.com/stark-act-and-fraud-abuse-issues/10 big-anti- kickback-cases-involving-hospitals-in-2010.html Showalter, J. S. (2007). Southwick’s the law of hospital & health care administration, 5th ed. Chicago: Health Adm. Press Watnik, R. (2000). Antikickback versus stark: what's the difference?. Healthcare Financial Management: Journal of the Healthcare Financial Management Association, 54(3), 66-67.

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