There are three most important federal anti-fraud healthcare laws that every provider should be familiar with:
False Claims Act (filing false claims),
Anti-Kickback Statute (offering/receiving remunerations for patient referrals, and providing free or discounted services), and
Physician Self-Referral Law (Stark law).
Government agencies have three vehicles to enforce these laws:
Civil Monetary Penalties Law, and
The Civil Monetary Penalties Law imposes significant penalties for filing improper claims, offering/receiving kickbacks, offering beneficiary inducements, and other improper conduct while providing healthcare services. Prior to 2018, the penalties ranged from $10,000 to $50,000 per violation. In the healthcare context, it’s not unusual for penalties to range in millions (for every claim submitted).
The Bipartisan Budget Act of 2018 has increased these penalties by twofold. For example, under the Civil Monetary Penalties Law, every anti-kickback violation may be subject to $50,000 penalty. The Bipartisan Act has increased it to $100,000 per violation. The Act also makes a kickback related violation a felony and has increased the maximum term of imprisonment from five to ten years. Note that the Act cannot be applied retroactively and is applicable only to violations committed after the date of enactment, February 9, 2018.
All healthcare providers accepting federally sponsored insurances, should scrutinize their Medicare billing practices, marketing agreements, referral arrangements, and promotional and advertising materials. Click here for a roadmap for healthcare providers, “Avoiding Medicare and Medicaid Fraud and Abuse” prepared by U.S. Department of Health and Human Services.