Combating allegations of healthcare fraud through kickbacks

On Behalf of | Aug 23, 2022 | Embezzlement, Federal Crimes

In New York City, Long Island and New Jersey, doctors are often subject to offers and requests from other medical professionals, drug companies and medical device manufacturers to use their products. In some cases, they are under the impression that there is nothing wrong with quid pro quo in the interest of furthering their practice and supplementing their income.

The federal government closely watches medical professionals to ensure they are not violating the Anti-Kickback Statute (AKS). When charges are filed, it can cause a litany of problems that must be addressed.

What should I know about the Anti-Kickback Statute?

Under AKS, medical professionals cannot accept “remuneration” (payment for work or services) to elicit business benefit, patient referrals or services or goods that come from healthcare programs under the federal government like Medicare and Medicaid. For example, getting a referral from one doctor to another to accrue payments from Medicare when the referral is not really needed could constitute fraud and a violation of AKS.

It does not limit itself to financial payments. It can come from something like a vacation or costly meals. Those who pay the remuneration can face charges under AKS just as the recipient can. The fines for violating AKS can be significant with up to $50,000 for each incident. They will also need to pay triple the remuneration.

Medical professionals are at risk of violating this law and many times, they are not even cognizant that they have done so. It might seem to be an honest exchange, but it is alleged to be a violation of AKS. Still, there could be a reasonable explanation. The referral that is being questioned might easily be valid and only take the appearance of kickback. Knowing how to craft a defense is crucial.

A consultation can help to clear misconceptions and chart a path forward

Even if the individual doctor, a joint practice or healthcare facility did not believe it was doing anything wrong, that does not change the reality that the allegations are being made, an investigation is taking place and charges are being filed.

Accusations that a physician violated the anti-kickback law can lead to various penalties, including fines, licensing problems and even incarceration. It will also damage reputations and have a negative impact on the future.

It is imperative to assess the evidence and determine the preferred course of action to combat the charges. There might not be enough to secure a conviction. There may be ways to suppress the evidence or have the charges dismissed entirely.

If there is a good chance of conviction, negotiating a plea bargain might be the way to go and avoid the worst possible legal and professional penalties. Or the opportunity for an acquittal can be there for the taking.

Consulting with professionals who will be honest about the situation and try to find a workable solution is a wise first step. Simply discussing the case with those who know what they are doing and can handle healthcare fraud cases with their skill and experience can assuage lingering anxiety. Before panicking or making the situation worse, calling for a consultation is a wise first step.