A New Jersey physician pleaded guilty last week to taking kickbacks for referring patients to a diagnostic facility. The doctor is facing a possible five-year prison sentence for taking less than $35,000 per year for referrals of patients to an MRI facility. He also must forfeit the almost $70,000 he received from the MRI facility.
A dozen other New Jersey doctors and nurse practitioners were arrested last week on similar charges of referring patients to the same MRI facility in return for kickbacks. An executive of the MRI facility was also arrested.
Under the federal Anti-Kickback statute, anyone who knowingly and willfully receives or pays anything of value to influence the referral of federal health care business, including Medicare and Medicaid, can be prosecuted for a felony. Violations are punishable by up to five years in prison, criminal fines up to $25,000, administrative civil penalties up to $50,000, and exclusion from participating in federal health care programs.
The statute contains a number of so-called "safe harbors" allowing certain types of business practices including investments in large publicly held health care companies; investments in small health care joint ventures; space rental; equipment rental; personal services and management contracts; sales of retiring physicians' practices to other physicians; referral services; warranties; discounts; employee compensation; group purchasing organizations; and waivers of Medicare Part A inpatient cost-sharing amounts. A number of "safe harbors" also exist in the context of managed care, including increased coverage, reduced cost-sharing amounts, or reduced premium amounts offered by health plans to beneficiaries; and price reductions offered to health plans by providers.
It is important to note that the conduct at issue must fit squarely within the "safe harbor" provisions in order to avoid potential civil and criminal consequences. If there is any doubt at all, health care providers may request an advisory opinion from the Office of the Inspector General at the Department of Health and Human Services.
If you are facing an investigation into possible violations of the anti-kickback law, or if you have questions whether a particular practice might violate the law, then you should consult with an experienced attorney immediately to protect your rights. To schedule a free initial consultation by telephone or in person, call our office today at (212) 601-2728 or click here to communicate with us via email.
John Howley, Esq.
New York, New York
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