The Anti-Kickback Statute (AKS) is a federal law that lawmakers intend to help better ensure physicians and other medical professionals focus on quality healthcare over financial gain. The law makes it illegal to file false or fraudulent claims for payment with government entities like Medicare and Medicaid; and violations come with serious penalties.
What are examples of violations of the AKS?
Common violations can include gifts from pharmaceutical companies in exchange for prescribing their medication or financial payments in exchange for referring patients to a specific specialist.
What are the potential penalties for a violation of the AKS?
Penalties can include tens of thousands in financial fees per violation as well as years of imprisonment.
Are there any exceptions to these rules?
Although noble in concept the reality of the application of the AKS does not always meet the intended goal. Overall, we want physicians and medical professionals to focus on the whole patient, which can benefit from collaborative efforts — but when is the effort one that benefits the patient and when does it cross the line?
Lawmakers recognized that this balance poses an issue and provided some safe harbors, essentially exceptions, the AKS. Examples include:
- Value-based arrangements. Certain collaborative efforts are allowed, but exceptions include certain arrangements with pharmaceuticals, labs, and medical device distributors and wholesalers.
- Transportation. In specified instances, the law will allow an exception for provision of local transportation within 75 miles for rural areas.
- Telehealth. There is also an allowance for certain telehealth options for in-home dialysis patients.
These rules are constantly evolving. As such, medical professionals are wise to conduct regular internal audits and review arrangements to mitigate the risk of allegations of a potential violation.
Attorney John Rivas is responsible for this communication.