Welcome back to MD Ranger’s blog series on risk management! We hope that these articles will help both you and your organization understand the ever-increasing need for strict, internal compliance procedures. Last week, we talked about the changes made by the Department of Justice (DOJ) to policy regarding individual accountability in corporate wrongdoing. This week, we dive headfirst into a discussion about the mediums through which both individuals and organizations can be held accountable for white-collar crime.
Being ‘held accountable’ is a nice way to say that you have been caught defrauding the government. The DOJ’s primary defense mechanism against fraudulent behavior are the Stark Law, the federal Anti-Kickback Statute (AKS), and the federal False Claims Act (FCA).
According to health law firm Barrett & Singal, the FCA imposes liability on individuals and facilities who submit false or fraudulent claims to the government for payment. Less obvious fraudulent behaviors often implicate healthcare organizations under nuanced aspects of this law. A majority of FCA come in response to claims for fraudulent Medicare reimbursements. The FCA has a qui tam provision, meaning that any individual possessing knowledge of a false claim can file suit against an entity on behalf of the federal government. If the suit is successful, the whistleblower is awarded a percentage of the penalties. We’ll talk more about this in the next installment.
To the left of the FCA rests the Stark Law. Stark Law is a civil law restricts physician self-referrals. Anyone who could have a financial stake in a physician’s practice cannot refer patients to to that physician. Stark Law is a strict liability statute, meaning that the government doesn’t have to prove that you intended to break the law. A Stark Law violation does not merit jail time, but offenders often incur devastating penalties. If the law was proven to be intentionally violated, a healthcare provider could be charged up to three times the original penalties–hundreds of illegal arrangements could mean hundreds of millions of dollars worth of fines.
Opposite Stark Law is AKS. The AKS prohibits both the offer and exchange of anything of value in order to entice or reward referral of healthcare services. AKS is a criminal statute–in addition to severe penalties, offenders could face a prison term of up to ten years per violation. The law is clear: it is illegal to solicit or reward referrals for any sort of compensation.
To learn more about these laws, access MD Ranger online resources here. Further questions or concerns? Email info@mdranger.com to get in contact with one of our experts.
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