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Violating the Anti-Kickback Statute and Stark Law in a Manner That Affects Medicare or Medi-Cal

The Stark Law (42 USC 1395nn) applies to healthcare providers who accept Medicare or Medicaid, while the Anti-Kickback Statute (42 USC 1320a-7b(b)) applies to benefits or payments under any federal healthcare program, including Medicare and Medicaid, among others. Stark Law violations can result in costly civil penalties, while violation of the Anti-Kickback Statute (AKS) can result in severe civil sanctions and criminal penalties as well. Prosecutions and enforcement actions could therefore come from many different sources, including the Federal Bureau of Investigation (FBI), the Department of Justice (DOJ), the Health and Human Services Office of the Inspector General (HHS-OIG), the US Attorney’s Office, the Centers for Medicare and Medicaid Services (CMS), False Claims Act lawsuits, and more.

The Law Offices of Art Kalantar provides strong and effective defense against charges of Medicare fraud, Medicaid (Medi-Cal) fraud, and other forms of healthcare fraud in Los Angeles and statewide. If you’ve been charged with giving or receiving kickbacks or unlawful referrals, it’s vital to get advice and representation from a skilled and knowledgeable healthcare law attorney. Before you give any statements to federal investigators or prosecutors that could damage your best defense, call our experienced California Anti-Kickback Statute and Stark Law defense lawyer for a free case evaluation.

The Stark Law – Physician Self-Referral

The Stark Law is also known as the physician self-referral act because that is what it prohibits. The Stark Law prohibits doctors from referring Medicare or Medicaid patients for certain health services to an entity that the doctor (or a member of the doctor’s immediate family) has a financial relationship with. Submitting claims to Medicare for services resulting from a prohibited referral would also be a violation of the Stark Law.

Stark Law violations can be punished through civil enforcement actions. Consequences can include being required to repay overpayments along with a civil assessment of up to three times the amount claimed. Civil monetary penalties as high as $15,000 for each service can be imposed for knowing violations, along with exclusion from participating in Medicare and Medicaid.

The Stark Law is a “strict liability” statute, meaning the government does not have to prove a violation was knowing to impose sanctions. Although penalties for “knowing” violations are more severe, the penalties for technical violations of the law are bad enough. The fact that the government does not have to prove intent makes it especially important to retain qualified legal counsel who is knowledgeable about the Stark Law and can mount an appropriate defense.

The Anti-Kickback Statute

The Anti-Kickback Statute (AKS) makes it a crime to knowingly and willfully make a false statement or representation of material fact in an application for payment from a government payer such as Medicare or Medicaid. Violations include offering, paying, soliciting or receiving anything of value to induce or reward referrals or generate business under a Federal health care program.

The AKS is a criminal statute, and punishment for a conviction can include up to $25,000 in fines and five years in prison per violation. The AKS can also be enforced through civil proceedings as well, including False Claims Act lawsuits and civil monetary penalties up to $50,000 per violation, assessments of triple the amount of the kickback, and exclusion from further participation in Medicare and Medicaid.

The law prohibits getting anything of value in exchange for referring patients to other providers, including exchanges for cash or in-kind benefits such as free health services for family members. Unlike the Stark Law, the AKS does include intent as a required element of the offense; violations must be “knowing and willful” to result in liability. The AKS also has safe harbor exceptions that specify certain payment practices which, although capable of inducing referrals, are shielded from criminal prosecution or civil sanctions.

Examples of potential Stark Law or Anti-Kickback Statute violations could include:

  • Offering kickbacks to patients to attend a clinic
  • Medical staff using gift cards to cover patient co-pays yet reporting co-pays to Medicare that were never charged to patients
  • Paying commissions to marketers to refer or paying patients to obtain compounded drugs that are deemed medically unnecessary in light of FDA-approved alternatives
  • Billing health plans for services not rendered

Corporate Practice of Medicine Doctrine

The Corporate Practice of Medicine (CPOM) is a California doctrine that prohibits someone without a medical license from employing physicians or co-owning a medical practice with a physician to provide medical services. This is a criminal offense in California, specifically a violation of the Medical Practice Act, punishable by up to $10,000 in fines and up to a year in county jail. CPOM, along with the Stark Law and the Anti-Kickback Statute, can all be used to put a healthcare provider in legal jeopardy for similar alleged violations. An experienced and dedicated California healthcare fraud defense attorney can protect you from enforcement actions brought on multiple fronts in relation to allegedly unlawful referrals or kickback schemes.

Contact the California Law Offices of Art Kalantar Today

Violating the Stark law or Anti-Kickback Statute can result in tens of thousands of dollars in fines, possible jail time, and exclusion from Medicare and Medicaid. A skilled and knowledgeable Medicare fraud defense attorney at the Law Offices of Art Kalantar can help you avoid a criminal conviction or civil liability and protect you from the worst consequences of an alleged violation. In Los Angeles and statewide, call our experienced California Anti-Kickback Statute and Stark Law defense lawyer at 310-773-0001 for a free case evaluation and immediate assistance getting you in the best position for a positive result.

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