One of the pillars of the medical industry is that the professionals that work in it are unbiased and unaffected by outside influences, especially when it comes to prescribing drugs and medicine or referring patients to other facilities and medical institutions. This is important for obvious reasons, but even well-meaning medical professionals can run afoul of the laws that relate to compliance without even realizing it.
The two laws that are closely connected with this idea are the Stark Law and the Anti-Kickback Statute. The Stark Law prohibits physicians from referring a Medicare of Medicaid recipient to a health care provider if they or an immediate family member have a financial stake or ownership stake in the provider. The Anti-Kickback Statute, meanwhile, bans physicians from accepting money after referring Medicare services.
The Stark Law is a civil statute, only applies to physicians, and requires a “preponderance of evidence” to prove the claim. The Anti-Kickback Statute, meanwhile, is a criminal law that requires proof beyond a reasonable doubt, and it can apply to all individuals receiving Medicare or Medicaid.
There are exceptions to these laws and statutes, as there are with any legal situation. But these are always serious claims, and the medical professionals accused of a Stark Law violation or an Anti-Kickback Statute violation need experienced legal representation to help them through these situations.
At Rivas Goldstein, we have extensive experience handling these types of cases and negotiating with federal regulators to defend our clients and to protect their interests and rights.