Quick Answer: What Is The Purpose Of The Anti Kickback Statute?

Does Anti Kickback Statute apply to private insurance?

In October of 2018 Congress enacted a new law that applies to many commercial health insurance plans, as well as Medicare and Medicaid.

Unfortunately, these provisions create expansive anti-kickback penalties for all private and commercial pay business.

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What is the beneficiary inducement statute?

The beneficiary-inducement statute prohibits providing free or discounted items or services to a Medicare or Medicaid beneficiary that are apt to influence the beneficiary to seek such reimbursable services from a particular provider.

How do you prevent anti kickback statute?

Five Tips For Anti-Kickback ComplianceBe aware of several safe harbors to the federal anti-kickback statute. … Implement and follow a compliance program for your practice. … Educate yourself about the risks. … Ask yourself whether certain gifts are legitimate. … Develop standards and procedures to address arrangements with other healthcare providers and suppliers.

What is the penalty for violating the Anti Kickback Statute?

Criminal penalties and administrative sanctions for violating the AKS include fines, jail terms, and exclusion from participation in the Federal health care programs. Under the CMPL, physicians who pay or accept kickbacks also face penalties of up to $50,000 per kickback plus three times the amount of the remuneration.

What is the difference between the Stark Law and the Anti Kickback Statute?

The AKS prohibits referrals for any kind of item or service where a kickback is involved, while the Stark Law prohibits only the referral of designated health services where a financial interest is involved.

What is a kickback in healthcare?

Kickbacks are arrangements made between providers in which one party refers patients to another through services, goods or medicines. … In this hypothetical, the physician is giving out medicine not to treat their patient’s condition, but because they are receiving payments from the company that makes the drug.

What is considered a kickback?

A kickback is an illegal payment intended as compensation for preferential treatment or any other type of improper services received. The kickback may be money, a gift, credit, or anything of value. … Kickbacks are often referred to as a type of bribery.

Is the Anti Kickback Statute civil or criminal?

The federal Anti-Kickback Statute (AKS) (See 42 U.S.C. § 1320a-7b.) is a criminal statute that prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of business reimbursable by federal health care programs.

Who enforces anti kickback statute?

Office of the Inspector GeneralAnti-Kickback Statute Penalties In addition, the Office of the Inspector General (“OIG”) for the Department of Health and Human Services (“HHS”) can pursue civil penalties of up to $50,000 per violation plus three times the amount of any government overpayment.

What is a false claim in healthcare?

The False Claim Act is a federal law that makes it a crime for any person or organization to knowingly make a false record or file a false claim regarding any federal health care program, which includes any plan or program that provides health benefits, whether directly, through insurance or otherwise, which is funded …

What are the goals of the Anti Kickback Statute?

FEDERAL ANTI-KICKBACK LAW AND REGULATORY SAFE HARBORS. Overview: On the books since 1972, the federal anti-kickback law’s main purpose is to protect patients and the federal health care programs from fraud and abuse by curtailing the corrupting influence of money on health care decisions.

What is an example of the Anti Kickback Statute?

Classic examples of violations of Anti-kickback and Stark laws include: … Drug companies paying kickbacks to insurers to get on their formularies; Payments by specialty pharmacies, DME suppliers, therapy centers, nursing homes, etc. to patient recruiters or to patients directly.