The Federal Anti-Kickback Statute (AKS) has been around since 1972 and is one of the most well-known enforcement statutes. As you know, it’s a criminal statute that prohibits offering, paying, soliciting, or receiving anything of value to induce or reward referrals or generate Federal health care program business. For example, a doctor can’t tell you to “go and see my cousin Johnny about the thing” because that would result in both the sketchy doc and his cousin lining their pockets. Jokes aside, it’s been a crucial enforcement tool in healthcare as it relates to the Federal False Claims Act.
Despite the Anti-Kickback Statute being around since the seventies, folks are still found non-compliant for all kinds of reasons. Luckily, there are so many things that we can do as compliance professionals to protect our organizations from AKS and False Claims Act non-compliance.
Just recently, in July 2021, a northern Ohio health system agreed to pay over $21 million to resolve False Claims Act allegations for improper payments to referring physicians and non-compliance with the AKS.
According to Justice.gov, “This settlement resolves allegations that between August 2010 and March 2016, AGHS paid compensation substantially in excess of fair market value to area physician groups to secure their referrals of patients, in violation of the Anti-Kickback Statute and the Physician Self-Referral Law, and then submitted claims for services provided to these illegally referred patients, in violation of the False Claims Act. The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded programs.
The Physician Self-Referral Law, commonly known as the Stark Law, prohibits a hospital from billing Medicare for certain services referred by physicians with whom the hospital has an improper financial arrangement, including the payment of compensation that exceeds the fair market value of the services actually provided by the physician. The Clinic voluntarily disclosed to the government its concerns with these compensation arrangements, which were put in place by AGHS’s prior leadership, and received credit for its cooperation in the resolution reached by the parties.”
Luckily, there are many things that we can do as compliance professionals to protect our organizations from AKS and False Claims Act non-compliance.
Tune into our free webinar, Uncovering the Anti-Kickback Threats Hiding In Your Organization, where we’ll discuss important things you can do to prevent non-compliance. I’ll go over recent AKS enforcement actions taken against healthcare organizations and providers. I’ll discuss why AKS non-compliance occurs so frequently (some might surprise you). And last but certainly not least, I’ll walk you through steps your compliance program can take to reduce the risk of AKS non-compliance.