Quick Answer: Does Anti Kickback Statute Apply To Private Insurance?

Does Anti Kickback Statute only apply to physicians?

Whereas the Anti-Kickback Statute applies to Medicare and any federal healthcare program, the Stark Law is limited only to Designate Health Services (DHS) paid for by Medicare.

Fourth, the Anti-Kickback Statute applies to any referral source, i.e.

not just physicians..

What is the beneficiary inducement statute?

The federal Beneficiary Inducement Statute (“BIS”) prohibits an individual or entity from providing remuneration to patients who are eligible for Medicare or Medicaid benefits if that individual or entity knows (or should know) that doing so is likely to influence the patient’s decision to order or receive items or …

Does the Stark law apply to private insurance?

The Stark Law, 42 USC § 1395nn, only applies to Medicare and Medicaid. The AKS, 42 USC § 1320a-7b(b)),applies to any federal healthcare program. This is because the Stark Law statute and the AKS were enacted at different times and are worded differently.

What is prohibited by the Anti Kickback Statute?

The AKS is a criminal law that prohibits the knowing and willful payment of “remuneration” to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients).

Does Stark law protect whistleblowers?

Stark law violations are a major source of qui tam cases filed by whistleblowers under the False Claims Act. … As they exist today, the Stark Law prohibits physicians from receiving a financial benefit for ordering, referring, or performing certain types of Designated Health Services (“DHS”).

What is a safe harbor under the Anti Kickback Statute?

The safe harbor protects certain arrangements when an individual or entity agrees to refer a patient to another individual or entity for specialty services in return for the party receiving the referral to refer the patient back at a certain time or under certain circumstances.

Is the Stark law a criminal statute?

§ 1320a-7b.) is a criminal statute that prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of business reimbursable by federal health care programs. …

What does remuneration mean under the Anti Kickback Statute?

Remuneration Under the AKS Means Anything of Value, Regardless of Its Form. Remuneration is not limited to cash, credit arrangements, gifts, supplies, equipment, excessive rent payment or tangible items.

What is Stark II law?

Stark II prohibits a physician or immediate family member who has a direct or indirect financial relationship with an entity from making referrals to that entity to provide designated health services (DHS) payable by Medicare or Medicaid, unless an exception applies.

Who does the Anti Kickback Statute apply to?

The Anti-Kickback Statute and Stark Law prohibit medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients who will receive treatment paid for by government healthcare programs such as Medicare and Medicaid, and from entering into certain kinds of …

What is an illegal kickback?

A kickback is an illegal payment intended as compensation for preferential treatment or any other type of improper services received. The kickback may be money, a gift, credit, or anything of value.

Does Stark law only apply to physicians?

The Stark statute applies only to physicians who refer Medicare and Medicaid patients for designated health services to entities with which they (or an immediate family member) have a financial relationship. There are almost 20 exceptions to the Stark statute.

What is the difference between the Stark Law and the Anti Kickback Statute?

The AKS prohibits referrals for any kind of item or service where a kickback is involved, while the Stark Law prohibits only the referral of designated health services where a financial interest is involved.

What is the purpose of the Anti Kickback Statute?

The AKS is a criminal statute that prohibits transactions intended to induce or reward referrals for items or services reimbursed by the federal health care programs.

What is an illegal provider relationship?

The Stark law prohibits a physician with a financial relationship in an entity from making a referral for designated health services covered by Medicare and Medicaid to that entity even if the services are billed to an individual or other third party payer.

What is an example of a kickback?

The definition of a kickback is slang for a bribe or incentive paid to someone who helped you make money, or a sudden, forceful recoil. When you bid on a job and job is awarded to you and you have to pay someone $1000 because your received the award, this $1000 payment is an example of a kickback.