The Anti-Kickback Statute (AKS) is a powerful legal tool the government can use to come after healthcare professionals it believes are fraudulently billing federal programs like Medicare and Medicaid. A violation can led to more than just civil penalties, as it is a criminal law.
This means that if the government can establish a violation they can push for imprisonment.
What constitutes a violation of the AKS?
The primary example is the use of illegal remuneration in exchange for patient referrals or the generation of business. In addition to straight cash payments, the courts have also found use of free or greatly reduced rent on facilities, luxury vacations, meals, and entertainment qualify as illegal remuneration for these purposes.
What are the penalties for a violation?
An AKS violation can come with the inability to file claims with federal programs in the future, up to $100,000 in financial penalties, and up to ten years imprisonment.
It is also important to note that these charges rarely stand on their own. If the government begins to investigate and build a case for an AKS violation, they will also look for additional evidence of wrongdoing. This often leads to the prosecution tagging on additional charges to the allegations of the AKS violation — which can also translate to additional penalties.
Do the courts really send doctors to prison?
They can and will. In one local example, New York courts sent a radiologist to prison for 48 months as a result of a relationship with an imaging center found in violation of the AKS.
Are there defenses to allegations of a violation of the AKS?
There are certain exceptions, known as safe harbors, which exclude certain acts from allegations of a violation. These safe harbors have strict requirements that you must meet to use this defense successfully.
Additional defense strategies may be available depending on the details of the situation.
Attorney John Rivas is responsible for this communication