The Department of Justice (DOJ) recently accused a hospital of Anti-Kickback Statute (AKS) and Stark Law violations. The allegations are the result of claims the hospital paid physicians high salaries based on the “volume or value of the physicians’ referrals.”
The federal government takes health care fraud very seriously. In 1996, the passage of the Health Insurance Portability and Accountability Act (HIPAA) resulted in the development of a national program focused on the investigation and prosecution of those who commit health care fraud crimes. The program, now in effect for over twenty years, has resulted in billions of dollars of awards.
The Department of Justice (DOJ) recently announced collection of over $2.5 billion dollars in judgments and settlements as a result of health care fraud cases. This is the ninth year in a row the government agency has collected over two billion dollars related to this form of fraud.
Allegations of Medicare fraud can extend beyond doctors, nurses and hospital executives. Those in other professions can also find themselves accused of abusing this system. A recent example involves a case out of the Southern District of New York.
President Donald Trump may change the rules regarding kickbacks in the medical field. His administration called for public comment on the matter in August. The agency took in public comments about the issue through October 26, 2018. The comments include many calls for changing the current Anti-Kickback Statute.
It began with a remodel project. A hospital in Northern New York decided to update its site. The project included the addition of new patient suites and upgrades, scheduled for completion in 2019. The cost of the project soared from $466 million to $545 million. Funds were not the only thing that allegedly got out of control during the renovation. Whistleblowers also came forward stating hospital officials were taking kickbacks to gain millions in fraudulent payments.
The results are in — Democrats gained at least 28 seats in the House of Representatives and have control of the chamber while the Republicans hold their majority in the Senate. This shift could impact a number of areas, including the push for regulatory relief in the healthcare industry.
The “Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communications Act,” also known as the SUPPORT Act, is a broad piece of legislation signed into law by President Donald Trump on October 24, 2018. The law will impact healthcare in many ways. One example: it is now often illegal for physicians to get any form of compensation related to referring a patient to certain laboratories.
The health care industry is heavily regulated. Various laws and court cases impact the practices of drug manufacturers, physicians, nursing homes and others in the medical field. Those that are part of this field are wise to stay abreast of changes that could impact their profession.
Allegations of kickback violations can lead to more than just harsh civil penalties, they can also lead to criminal charges. That was the case when the government accused a national hospital chain of various forms of healthcare fraud, including kickback violations.