Could my insurance company be giving my healthcare providers kickbacks?
The Anti-Kickback Statute and Stark LawStark LawStark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity for the provision of designated health services (“DHS”) if the physician (or an immediate family member) has a financial relationship with that …
What is kickback healthcare?
It’s simple to define what kickbacks in health care are. If a physician or medical provider uses any payment or compensation to encourage a patient to come to their office, or to encourage another medical provider to refer patients to their office or facility, that is a kickback.
What are examples of kickbacks?
Kickback Examples
- Gifts. Any gift of above nominal value, including things such as food, event tickets, and gift cards, is an improper kickback. …
- Bribes. …
- Over Billing. …
- Diverting business to vendors. …
- Using payments or compensation to refer patient. …
- Conflict of Interest.
What is the difference between the Stark Law and the Anti-Kickback Statute?
The Anti-Kickback Law covers referrals for all services from anyone including physicians or pharmaceutical companies. Conversely, the Stark Law is for referrals from physicians only and covers a set list of “Designated Health Services” (DHS).
What is the intent of the Anti-Kickback Statute?
The AKS is a criminal law that prohibits the knowing and willful payment of “remuneration” to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients).
Are physician kickbacks illegal?
The Anti-Kickback Statute and Stark Law prohibit medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients who will receive treatment paid for by government healthcare programs such as Medicare and Medicaid, and from entering into certain kinds of …
Is it illegal for doctors to kickback?
The Medicare/Medicaid statute says a violation of its kickback statute is a felony, punishable by fines not to exceed $25,000 and 5 years in prison.
How do you identify a kickback?
To identify kickbacks, security services often use frontline methods such as test purchases . During the checkout, the “buyer” proposes a rollback and step by step captures the behavior of the sales manager or purchasing manager.