Deeper Than The Headlines: Marketers & Physicians Settle Lab Allegations

Transcript:

Hello, everyone. Welcome to another one of our videos from the series deeper than the headlines. My name is CJ Wolf with Healthicity. In this series, we try to go a little bit deeper than what we read in the headlines on these enforcement cases as it relates to health care compliance. And the case I wanted to talk about today, is interesting because it it is con continuing a trend that I'm seeing in recent enforcements and relates to the anti kickback statute. So remember, the anti kickback statute or the AKS is, a law in health care that says you cannot offer anything of value, renewed remuneration, or, kickbacks. It's not always cash. It could be something of value, and you cannot ask or receive these things in exchange for referrals for for health care services. And what we've seen historically is that these kickback settlements usually focus on the giver of the kickback.

So we've seen this in pharmaceutical companies, for example, medical device companies, where they are the giver of the item of value usually to a hospital or to physicians. And then what is is generally expected is in return that the doctor or the hospital uses their drugs or prescribes their drugs or uses their medical devices, and that those decisions are based off of, financial influences instead of just what's best for the for the patient. But the law also talks about those who recede. What I've been seeing in the last few years is a little bit more focused from the Department of Justice, on the receiver. And, usually, those receivers are, like I mentioned, either hospitals or doctors. And what I've seen a lot is that more and more doctors are being, subject to enforcement as well. And in the case that I'll share, and we'll share the link here, it has to do with laboratory.

You know, and laboratories make their money off of getting labs, you know, samples to to run their laboratory tests on and then to provide those back. And so, they're interested in getting more and more they're interested in getting more and more referrals from from providers. And what was alleged in this case and and and the settlement was for over one point five million dollars. And at first, these are allegations, so this doesn't these haven't gone to court. So no one is admitting, guilt or fault necessarily. So but they are settling for large amounts of money. And, in this particular case, the it was alleged that the laboratory was offering financial incentives through and disguised in a way through consulting fees or through medical directorship fees. Now those are both valid things that doctors can do on behalf of other entities.

However, they have to be legitimate. Right? So the the the contracts have to spell out exactly what's being done, and then the the doctors have to actually provide those services. It can't just be some sort of, yeah. We'll we'll sign a contract here, and we'll just give you five thousand dollars a month regardless of whether what you regardless of whether you do something or not. Now the contract's usually gonna read and be nice and clean and say, hey. We'll do x, y, and z. But the truth is in the pudding. Right? It's did you actually do those things? And so, in this particular case, there were marketers who, were, incentivizing doctors to send referrals to these laboratories. And and some of those marketers were actually receiving commissions based off of the volume of referrals that the doctors were sending to the laboratory. And, again, the exchange of money was through, consulting fees and medical directorship type of fees. And so the laboratory had to pay a large portion, but this is what I am thinking is very interesting and I've seen more and more of.

Department of justice went after five physicians in their organizations, their their medical practices for accepting these types of these types of payments and and then sending referrals to that particular laboratory. And so, that is, to me, really interesting that DOJ is focusing in more. Again, this is anecdotal, but it it's what I'm seeing as I read all of these headlines. They seem to be focusing more and more on the receivers as well.

Because it takes two to tango. Right? It takes somebody to offer. It takes somebody to receive. Now the anti kickback statute can be enforced if there's only one person offering, or one person asking for. Right? But, in this particular case, both parties were involved. There was somebody offering, and there was somebody receiving. So I thought that was really interesting. And keep in mind too that, with the anti Quebec statute, there are some safe harbors that you can fit into. So there are ways to to, conduct business in health care, but you have to do it in the right way. 

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This transcript has been auto-generated. Please forgive any mistakes.