DC Kickback Whistleblower Cases

    The following is taken from an interview with Tony Munter as he discusses kickback schemes including what they are and why they are prohibited. To learn more about kickback schemes call today and schedule a free consultation with a DC False Claims Act and healthcare fraud lawyer.

The anti-kickback statute allows prosecution of a kickback and makes very clear that the kickback doesn’t have to be in the form of cash, although certainly cash can be a kickback. The question is whether a doctor or anyone has been induced to provide a service or make a prescription, or something like that, illegally or whether somebody has gotten a referral in exchange for what’s called remunerations.

Anything can be a kickback as long as it’s a value to the person being induced or the person receiving – giving the referral for business. In fact, a referral for referral could be a kickback. I’ve seen discussions of cash, I’ve seen questions about whether or not expenses about entertainment and travel and all sorts of things can, at least in theory, be a kickback. In addition, money obviously still counts as a kickback.

There’s any manner you could think of that would induce a doctor or a hospital or something like that to use a product or prescribe a drug or order a service that could be paid for by government healthcare program, anything at all could work as kickback.

What is the Stark Law?

The Stark Law is a little more specific in that it prohibits referrals when doctors have a particular financial interest in an institution. The idea is to prevent a physician from making referrals to their own entities, separate that from a medical decision. The doctors aren’t ordering unnecessary tests and ordering unnecessary procedures just to make money for their own financial groups. That’s what the Stark anti-self-referral law is about.

Why Are Kickbacks Prohibited By Healthcare?

Well, I think the public policy reason behind both the Stark anti-self referral law and anti-kickback statute is we all want our medical decisions to be made on the basis of medicine and not on the basis of business.

There’s such a potential for directing business one way or the other within the healthcare field that it was decided that directing business as a result of inducements, rather than on straight medical decision, was something that really needed to be protected against.

When we go to the doctor we expect the doctor to give us their unbiased medical advice. We don’t expect that advice to be tainted in any way by potential for the doctor to make money. That’s why these laws came into existence, because otherwise it will be such an easy way for somebody to make additional money and everybody is subject to that type of temptation.