The Anti-Kickback Statue is an intent-based statute with civil and criminal penalties that prohibits offering anything of value to induce referrals of federal healthcare services. The Stark Law prohibits physicians and other providers from self-referring Medicare and Medicaid patients — with or without intent — to other health services if a physician or a physician’s family member has a financial stake in the referred business unless an exception applies.
Especially now, enforcement of the laws is more aggressive as whistleblower lawsuits proliferate. What is more, many Anti-Kickback and Stark Law violations frequently can be used as the basis for False Claims allegations. In fact, Anti-Kickback Statute and Stark Law violations now make up most False Claims Act cases.
False claims liability, the expansion of the Fraud Enforcement Recovery Act and changes in the PPACA have caused increased enforcement of the Stark Law to include knowingly withheld overpayments, even without false records, and the requirement to return overpayments within 60 days of identification.
As hospitals face increasing enforcement under these changes, they are at risk for steep damages: Stark Law penalties are charged per service and can add up to $15,000 each, and damages under the False Claims Act can cost up to $11,500 per claim submitted. This means violations can result in settlements that total hundreds of millions of dollars.
In light of these risks, healthcare systems are challenged to keep up with recent regulatory enforcement actions and proactively implement strategies to avoid the consequences of these laws and regulations.
To learn more about how to insulate your physician agreements from Stark and Anti-Kickback Statute risk, join Becker’s Hospital Review and MediTract for a complimentary webinar. Bret Bissey, MBA, FACHE, CHC, CMPE, senior vice president of compliance services at MediTract, and Sean McKenna, partner and co-chair of the Healthcare Practice Group of Haynes and Boone, will lead the presentation, examining tested strategies for enforcement actions and how to implement them, as well as tools and technologies to support enforcement actions.
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