The United States Centers for Medicare and Medicaid Services (CMS) has strict rules when it comes to business relationships between healthcare providers who file claims for payment from Medicare. Two primary examples are the Anti-Kickback Statute (AKS) and the Stark Law.
What are these laws?
The AKS is a criminal law that prohibits healthcare providers who use federal healthcare programs like Medicare to provide payment in exchange for patient referrals. Payment can range from actual cash payments to gifts like luxurious vacations or meals. The Stark Law, also commonly known as the Physician Self-Referral Law, prohibits physicians from referring patients for services that are payable by Medicare or Medicaid when the physician has a financial relationship.
It is important to note that there are safe harbors and exceptions to both laws but navigating these legal loopholes is not easy. It is a good idea to have a legal professional experienced in this niche area of healthcare law provide guidance to mitigate the risk of an unintentional violation as penalties can include steep financial penalties as well as potential imprisonment.
Why is there an increased focus on hospice centers?
There are reports that the feds are keeping a closer watch on these types of relationships, specifically when it comes to hospice services. One area of concern is the rise in hospice centers offering “upstream services” like palliative care and home health services. Those who are looking to expand into this arena are wise to do so carefully. A single misstep could trigger allegations of a violation and violations can come with harsh consequences.
Attorney John Rivas is responsible for this communication.