One of the most important federal laws for physicians to know is the U.S. Anti-Kickback Statute. Under the AKS, it is illegal for physicians to knowingly solicit or receive direct or indirect compensation in exchange for patient referrals or economic gain involving services payable by Federal health care programs, such as Medicare and Medicaid.
However, many doctors are unaware that their actions may violate this law and that they could face serious charges of fraud or abuse.
1. What constitutes remuneration?
Cash payment is not the only type of compensation that applies under the AKS. Any item of value may constitute remuneration. In addition to offers of free rent, upscale meals or hotel stays and other luxury gifts, it may be an anti-kickback violation to accept disproportionate compensation for a consulting or directorship position.
2. What about waiving copays?
The law generally allows physicians to waive copays on a case-by-case basis if a patient cannot afford to pay. However, routinely waiving Medicare or Medicaid copays or advertising the willingness to waive copays could violate the AKS as an act of inducement to program beneficiaries.
3. What are the penalties under the AKS?
Under the Civil Monetary Penalties Law, physicians may have to pay tens of thousands of dollars per kickback as well as three times the amount accepted in remuneration. Doctors who violate anti-kickback law may also face criminal penalties, including jail time, and they may no longer be able to participate in Federal health care programs.
Unfortunately, fraudulent actors in the health care industry often target doctors for kickback schemes. Physicians must be careful when accepting any remuneration for items that do not involve direct patient care if they want to avoid charges of fraud or abuse.