Stark Law and Anti-Kickback Statutes
Stark law and the Anti-Kickback Statute are in place in order to keep doctor-patient decisions out of business considerations. Such illegal actions should be reported to the government in order for justice to be handed out fairly and swiftly. However, whistleblowers should consult with a seasoned DC attorney with noteworthy experience in dealing with these types of cases. A DC lawyer may be able to guide you through the process of reporting this crime.
What Is the Stark Law?
Stark law is actually a set of regulations that prohibit the self-referral of patients under government programs by physicians to either themselves or entities in which they have a financial relationship. This law is a powerful tool under the False Claims Act (FCA) because it also confers liability under the False Claims Act. A person could be fined $15,000 every time they break the law. More importantly, for whistleblowers, the law confers automatic liability under the FCA. The defendant could also be held liable for the full amount of any such claim.
This law is a powerful tool under the False Claims Act (FCA) because it also confers liability under the False Claims Act. A person could be fined $15,000 every time they break the law. More importantly, for whistleblowers, the law confers automatic liability under the FCA. The defendant could also be held liable for the full amount of any such claim.
Exceptions to Stark Law
Exceptions to Stark Law are known as “safe harbors”. If someone is engaging in in an activity that would normally be considered to be a violation of Stark Law, but that activity falls within a safe harbor of Stark Law, the provision would not apply.
Safe harbors, however, are very specific. They must be looked up very carefully and all requirements must be met. Partially fulfilling a safe harbor is not enough. A Stark Law lawyer in the District of Columbia could help you demonstrate an exception to Stark Law when preparing for a defense.
What are Kickbacks and Why is it Considered Fraud?
Kickbacks are a form of bribery in which payments are made with the purpose of gaining something from either a company, person, or both. Referring a patient could be seen as a kickback in some cases. If a doctor is consistently referring a patient to a pharmacy and that pharmacy then sends patients to the physician, those could be considered reciprocal kickbacks. The action of referring to a new business could also be considered a kickback. These cases may be harder to prove, but they do occur.
Penalties for Violating the Anti-Kickback Statute
Defendants accused of violating the Anti-Kickback Statute (AKS) could face both civil and criminal penalties. In regards to the False Claims Act, the law may confer immediate liability under the False Claims Act. The full amount of any claim tainted by a kickback is actionable as a false claim, which could also make it subject to treble damages.
There are civil penalties for breaking Stark Law itself which can be assessed on a per-attempt basis. A violation of the Stark Law regarding False Claims Act is also material to the government’s decision to pay, so the full amount charged under a violation of the Stark Law might be something that is considered a violation of the Stark Law. It would be recoverable under the False Claims Act as damage.
What Health Services are Covered Under Stark Law?
The technical term for health services covered under Stark Law is called “Designated Health Services.” However, not all health services fall under that. Stark Law covers a great many services under designated health services, including clinical laboratory services, physical therapy services, radiation, durable medical equipment, prosthesis, home health services, outpatient prescription drugs, and in-patient and out-patient hospital services.
If a physician prescribes a drug through a pharmacy in which they have an ownership interest, that could be a reason to suspect a Stark Law violation because they would have a qualifying financial relationship with the pharmacy in prescribing or steering a patient to that pharmacy.
Incentives for Exposing Fraudulent Physicians Violating Stark Law
Under the False Claims Act, a whistleblower who exposes violators could obtain an award of 15% to 25% in a case that is intervened by the government. Whistleblowers could also collect 25% to 30% of anything the government collects in a case that is not intervened.
Stark Laws and Anti-Kickback Statutes Do Not Apply to Private Insurance
The Anti-Kickback Statute and Stark laws do not apply to physicians who are not offering services covered by some government programs, such as Medicare or Medicaid. The Stark Law applies to government programs and it does not apply to private insurance. Government programs include programs such as TRICARE, which is the military’s health service.
There are two states that have laws that apply to private insurance. The Stark Law is federal, but it is possible that similar anti-self-referral statutes may apply under those circumstances. It is also possible that states may have enacted similar legislation with respect to private insurance, which is mostly regulated at a state level. It is possible that similar laws apply under private insurance in theory, but the Stark Law is meant to apply to government programs.
Learn More About the Stark Law and Anti-Kickback Statutes
If you have incriminating information of someone in violation of Stark Law and anti-kickback statutes, it is essential to get in touch with an attorney who has experience in dealing with whistleblower cases. A tenacious DC attorney can walk you through the process of presenting this information from the government as well as potentially providing you with legal protection from the accused party. Schedule a consultation today to get started on your case.
