Things about the Anti Kickback Statute you should know about
The Anti Kickback Statute focuses on referrals of residents or services which are paid for, in whole or in part, by any federal health care program, including Medicare and Medicaid. To understand this Statute, you have to understand what referrals really mean and the legal way to give and receive them.
Nursing facilities may make or receive referrals of federal healthcare programs in many different ways. There are a few obvious ways in which nursing facilities such as these may get referrals. They are: physicians, hospices, hospitals and nursing homes, hospital discharge planners, other health care medical professionals, home health agencies and other nursing facilities. Other than this, direct referrals of residents in the nursing facility, and referrals of items and services may also be received. For this, the federal government reimburses the nursing facility from different sources such as physicians, other health care professionals and pharmacists.
Other than this, nursing facilities are also known to make referrals or even influence referrals for the services paid to other health care providers by the federal government. This may include hospices, laboratories, long term care pharmacies, physicians, durable medical equipment, diagnostic testing facilities, hospitals and other nursing facilities.
According to the rules laid down by the Anti Kickback Statute, all these referrals must comply with it. What the statute does is it places limits on the business arrangements that are related directly or indirectly to the services and items paid for by a health program of the federal government. It may also often restrict business arrangements which are not a problem in any other setting than health care.
The Anti Kickback Statute is criminal in nature and it prohibits the accepting, giving, soliciting or arranging items of value in a way that directly or indirectly may be used for the purpose of rewarding or inducing another party for referrals of the services in a federal government health care program. The good thing about the Anti Kickback Statute is that it is very broad in its view and takes into account the varied malpractices that go on in the medical field. Other than the referrals by residents, the statute also covers the ordering, arranging, leasing or purchasing for or soliciting the ordering, arranging, leasing or purchasing any service that has been paid for by a federal health care program in exchange for anything of value.
Anyone found guilty of disregarding the Anti Kickback Statute may have to spend time in the jail because this statute is criminal in nature. Other than the jail term, the guilty party may also have to face exclusion from any federal health care program in the future and criminal money penalties. Anyone involved in a prohibited transaction may face these penalties including the giver or receiver for referrals of prohibited benefits.
The Anti Kickback Statute is a milestone in bringing medical fraud to the forefront of public consciousness. This statute tries to bring some regulation in the vast unkempt field of medical referrals.
