Understanding Anti-Kickback Laws
There are both federal and state laws regarding kickbacks in healthcare. The state’s anti-kickback rules are detailed in Florida Statutes Section §456.054. The state defines a kickback as “a remuneration or payment, by or on behalf of a provider of health care services or items, to any person as an incentive or inducement to refer patients for past or future services or items.”
What exactly is prohibited? Florida § 456.054(2) spells it out clearly: Healthcare providers may not “offer, pay, solicit, or receive a kickback, directly or indirectly, overtly or covertly, in cash or in kind, for referring or soliciting patients.”
There’s a very important distinction between the federal and the state anti-kickback laws that those in Florida healthcare industry should understand. Federal law says that to be convicted of fraud, the violation must have been made “knowingly and willingly.” In contrast, the state of Florida isn’t concerned with whether or not healthcare workers knew they were in violation; they can be found in violation even if the act was not willful or purposeful.
Types of Kickback Schemes
The anti-kickback laws are fairly broad, so numerous types of actions may be considered infractions. To get a better picture of what could constitute as a violation, take a look at these recent real-life examples of alleged cases of anti-kickback law infractions:
- Valentine – The Office of Inspector General (OIG) alleged that Thomas C. Valentine, a former Sanofi pharmaceutical sales rep gave physicians samples of the viscosupplement Hyalgan with the expectation that the doctors would bill Medicare for the samples. He provided a certain number of samples with orders of a specific size with the expectation that the physicians would continue to use the product. Valentine won’t be allowed to participate for five years in federal programs for this violation.
- Lux – Paul Lux, M.D., agreed to pay $63,900 after the OIG said a medical device manufacturer paid him under a clinical registry contract.
- Dorminy – Dorminy Medical Center paid $50,000 after the OIG said the medical center paid a doctor by providing free use of hospital space.
Penalties for Breaking Anti-Kickback Laws
Penalties for kickback law violations can be severe. Not only could there be sanctions on a practice, but the state of Florida also considers it a third-degree felony. This means:
- up to five years in prison; and
- up to a $5,000 fine.
Those facing federal charges may face up to five years in prison, as well as steeper fines up to $25,000. They could face civil administrative penalties in addition to criminal fines. Penalties may include prohibition from participating in any government health programs.
If Under Investigation for a Kickback Scheme, Consult a Lawyer
If you’re found in violation of kickback laws, harsh penalties could ensue. You’ll need an attorney who has the skills necessary to create a strong defense and to protect your rights while under investigation for any type of healthcare scheme. If you are in or around the Fort Lauderdale area, call the Law Offices of Robert David Malove for a consultation. Contact our firm today to schedule a free, no-obligation consultation – (888) 744-8225.