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Physicians need to know these 3 payment regulations

The Office of the Inspector General (OIG) will investigate allegations of illegal physician payment arrangements. Physicians are wise to take proactive action to protect themselves from allegations of wrongdoing.

One way physicians can mitigate their risk for violating these laws is to be familiar with the basics of these regulations. Three examples that physicians should know include:

  • Stark Law. Physicians cannot refer their patients to other physicians with whom they have a financial relationship or to facilities where the physician has an ownership interest. This law also extends to include referrals when an immediate family member would realize a financial benefit.
  • Anti-Kickback Statute. This law makes it illegal to receive payment in exchange for making a referral.
  • False Claims Act. It is illegal for physicians to make a false claim to Medicare or Medicaid. Under this law, individuals can file a lawsuit on behalf of the federal government if they believe the medical facility is defrauding the government by filing false claims for Medicare or Medicaid reimbursement. These are referred to as qui tam or whistleblower lawsuits.

Lawmakers drafted these regulations to help better ensure physicians focus on care for their patients as opposed to financial gain. Unfortunately, the minutiae of the laws can hinder the ability for physicians and other medical professionals to work together to better ensure patients receive a high quality of care.

A misunderstanding could result in false allegations of wrongdoing. Physicians that find themselves facing such allegations are wise to act to protect their interests. An attorney experienced in the niche area of health care law.