What is a Kickback?
A kickback is generally defined as a transaction wherein a pharmaceutical institution, hospital, care provider or physician provides an incentive to patients, providers, and other individuals, to encourage or refer patients to visit their facility or use their services. These incentives can be in the form of payments, benefits, goods and/or medicines. Kickbacks are a direct violation of the False Claims Act.
To illustrate, the following example involves a kickback: Company A, a pharmaceutical company, invites providers to “speaker events” including lavish dinners and entertainment, to encourage them to prescribe their drugs and products. The more drugs the providers prescribe, the more perks they receive from Company A. Such acts of unethical conduct often impose a tremendous financial burden not just on the patient, but the hospital, the government and the taxpayers as well.
Anti-Kickback Statute and the Stark Law
Whistleblowers or insiders with information about kickback schemes can report fraudulent activities by using the top whistleblower lawyers at Brown, LLC and filing a “Qui Tam” lawsuit under the False Claims Act. If successful, whistleblowers can receive a significant financial reward for reporting the fraud. There are two primary laws that prohibit kickbacks in the healthcare field.
The Anti-Kickback Statute
Healthcare professionals have a duty to prioritize the health of their patients, but their medical judgment is often overshadowed by greed. Hence, the Anti-Kickback Statute (“AKS”) prohibits medical providers and physicians from paying or receiving kickbacks or any financial benefits in return for referrals of patients who are covered under federal healthcare programs such as Medicare, Medicaid and TRICARE. The AKS also aims to ensure that decisions by providers are made in the best interest of their patients and not to line their own pockets. Numerous courts have held that a violation of the AKS is a per se violation of the False Claims Act.
The Stark Law
The Stark Law similarly targets improper physician and provider referrals, and is possibly broader in scope than the Anti-Kickback Statute. Unlike the AKS, which requires there to be a kickback or financial benefit, the Stark Law can be violated just by the improper referral itself.
Specifically, the Stark Law is violated when a physician refers patients to an entity to which the referring physician, or his or her immediate family member, has a financial relationship. This means that, generally speaking, if a physician refers a patient to a clinic owned by his family member, the Stark Law could be violated.
It is important to note that the Stark Law has many exceptions, however, especially for referrals within group practices, managed care programs, and providers in rural areas. Moreover, the Stark Law only covers certain services, including:
- Clinical laboratory services
- Physical therapy services
- Occupational therapy services
- Outpatient speech-language pathology services
- Radiology and certain other imaging services
- Radiation therapy services and supplies
- Durable medical equipment and supplies
- Parenteral and enteral nutrients, equipment and supplies
- Prosthetics, orthotics and prosthetic devices and supplies
- Home health services
- Outpatient prescription drugs
- Inpatient and outpatient hospital service
Healthcare entities are prohibited from submitting claims to Medicare and Medicaid for services performed due to a physician referral.
Reporting Kickbacks in Healthcare the Right Way
Whistleblowers have over the years helped the government recover billions of dollars by reporting healthcare misconduct like Kickback schemes that violate the Anti-Kickback Statue and the Stark Law, and thereby helped to protect patients, taxpayer dollars and the integrity of the healthcare system.
You as an insider witnessing healthcare abuse and waste in the form of kickbacks at a medical office or pharmaceutical company could help uncover those who undermine the system and put lives at risk. If you blow the whistle the right way, you can provide an important public service and win a whistleblower award that’s a percentage of the potentially millions of dollars recovered by the government. If you blow the whistle the wrong way, your case could be over before it begins. Contact us at Brown, LLC today to discuss your case confidentially at (877) 561-0000.