The federal Anti-Kickback Statute (AKS) is a crucial law in the healthcare industry. It criminalizes the act of paying someone to refer patients or generate business when any form of state or federal healthcare program funds—such as Medicare, Medicaid, CHAMPUS, and TriCare—are involved. Many states have their own versions of this law. While it seems straightforward, many physicians and healthcare businesses find it challenging to comply with this foundational healthcare regulation.
Case Study: A Warning from North Carolina
Consider the case of a medical practice in North Carolina. The practice routinely sent patients’ blood work to a lab—a common procedure in the medical field. However, issues arose because the practice:
- Billed Medicare for phlebotomy services,
- Received space rental payments from the lab, and
- Leased a chemistry analyzer from the lab and submitted false claims to Medicare.
All the financial transactions between the lab and the practice were deemed kickbacks. While none of the practice’s physicians or managers went to prison, the settlement cost the practice a staggering $625,000.
Stay Compliant and Informed
Healthcare professionals and providers must be vigilant. If you receive anything of value—be it money, tickets, or otherwise—from an entity paid for healthcare items or services, consult your healthcare regulatory lawyer without delay. Compliance with the AKS is not just about understanding the law but also about safeguarding your practice from severe financial penalties.
