What Is A Medical Fraud Kickback?

In the previous blog entry, our authors discussed the definition of healthcare fraud, how someone could be charged with healthcare fraud, and reviewed the scheme that criminal defendants were charged with in Florida. In this blog entry, we will discuss kickbacks, what they are, how common they are, and why they are in violation of two federal statutes regarding healthcare law. Medical fraud is much more prevalent than we realize, but the Department of Justice, HHS and OIG are cracking down on offenders.

What are Kickbacks?

Kickbacks are undisclosed or “under the table” financial agreements between a physician or practice group and other healthcare entities. A healthcare provider pays the other provider, pharmacist or therapist a kickback (small finder’s fee) every time the other provider refers him to a new patient, whether or not it is medically necessary. Often kickbacks occur from a primary provider up to a specialist, or for a patient who apparently needs durable medical equipment despite no injury occurring. In the instant case discussed last week, the defendants paid kickbacks to other healthcare providers for referring patients to their detox clinic.

Kickbacks are illegal because the financial incentives lead healthcare providers to make unnecessary referrals for their patients or refer their patients for treatment that offers them no medical benefit or is not medically necessary based on their condition. Instead of considering the best option for the patient, the doctor is concerned with their own financial gain.

What is the Anti-Kickback Statute?

Whistleblowers can report illegal kickbacks under the False Claims Act. The Anti-Kickback Statute prohibits receiving anything of monetary value in exchange for a referral, and it covers any items or services paid for by healthcare programs. 42 U.S.C.§1320a-7b.  Violators of the Anti-Kickback statute face federal criminal and civil penalties. A defendant convicted under the AKS can be sentenced to up to ten years in prison and compelled to pay up to $100,000 in fines. They may also be suspended from seeking future reimbursements through Medicare or Medicaid.

A doctor or a medical device company, pharmacist, therapist or detox facility could possibly be charged with violation of the statute if a bribe was utilized to induce the physician into referring patients. Even if a doctor did not actually take the kickback, if a party worked to conceal an illegal financial arrangement, they could be charged with a misdemeanor under the statute.

 Contact West Palm Beach Criminal Defense Attorney William Wallshein

If you or someone you know are under federal investigation for medical fraud in South Florida, receiving or paying kickbacks, or violation of the Anti-Kickback Statute, it is imperative you contact a seasoned federal criminal defense attorney immediately. You could be facing years in prison in addition to irreparable damage to your livelihood, your reputation and life as you know it. West Palm Beach criminal lawyer William Wallshein is a respected litigator with more than three decades of experience handling federal criminal defense cases. He understands what is at stake and he goes to bat for his clients. Call today to schedule a free, comprehensive consultation.

Sources:

law.cornell.edu/uscode/text/42/1320a-7b

oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/