Every physician and ambulatory surgery center should know how to avoid violating federal statutes that protect taxpayer money from unscrupulous or unknowledgeable healthcare providers. Here are three laws every ASC and doctor should know:
- The Anti-Kickback Statute (42 USC § 1320a-7b(b)): this criminal statute prohibits the exchange of anything of value to reward or induce referrals or generate business that involves federal healthcare business and funding, such as Medicaid and Medicare patients and reimbursements.
Convictions can result in fines up to $25,000 and imprisonment for up to five years, as well as mandatory exclusion from federal healthcare programs.
Civil penalties can result in a civil monetary penalty of $50,000 per violation and a civil assessment of up to three times the amount of the kickback.
- The False Claims Act: Individuals have the right to bring qui tam actions alleging violations of the Anti-Kickback Statute. So when someone sues on behalf of the federal government and succeeds, the person who sued receives a percentage of the recovery.
- The Stark Law (42 USC § 1395nn): A physician is prohibited from referring Medicare patients for designated health services to an entity with which the physician or an immediate family member has a financial relationship. They also are prohibited from submitting claims to Medicare for those services that result from a prohibited referral.
Penalties include an overpayment or refund obligation, a False Claims Act liability, civil monetary penalties, and a potential civil monetary penalty of $15,000 for each service and a civil assessment of up to three times the amount claimed.
- Department of Health and Human Services