Health care fraud and the Anti-Kickback Statute

On Behalf of | Nov 15, 2019 | Health Insurance & Medicare Fraud |

As a medical professional, such as a doctor or nurse, you’re familiar with what you are and are not permitted to do in regard to how you treat patients. However, when it comes to billing standards, such as how to bill an insurance company or Medicare, you may not have nearly as much knowledge of what’s required of you.

Health care fraud is a serious crime that can result in severe penalties that can alter your life.

For example, kickbacks are among the most common forms of health care fraud. This form of bribery comes into play when a medical professional receives a financial benefit in exchange for offering a referral to another doctor or facility.

Take, for instance, a Medicaid patient who requires home health care in the future as a result of a recent injury or illness. If a doctor receives payment or any other type benefit from a home health care agency in exchange for the referral, it’s considered fraudulent activity.

What is the Anti-Kickback Statute?

The Anti-Kickback Statute was designed to protect against health care fraud relating to federal programs including but not limited to Medicaid and Medicare.

As the name suggests, it forbids health care professionals from accepting kickbacks from providers, agencies and facilities.

In addition to money, other common types of kickbacks include:

  • Free trips
  • Entertainment tickets
  • Free meals
  • Paid contracts

It’s easy to believe that you can fly under the radar of the Anti-Kickback Statute, but the federal government is serious about pinpointing those who violate the act. In the event of a conviction, penalties can include:

  • Civil penalties: A fine reaching as high as $50,000
  • Criminal penalties: A fine reaching as high as $25,000, along with a maximum of five years in prison

Keep in mind that the penalties above are on a per violation basis. So, if there are three acts of violating the Anti-Kickback Statute, criminal penalties can max out at a $75,000 fine and 15 years in prison.

If you’re ever charged with health care fraud, it’s important to get serious about defending yourself. You have legal rights, and protecting them is of utmost importance. Failing to do so could result in serious civil and criminal penalties, as well as losing your license and livelihood.