What is the Anti-kickback Statute?

The Anti-Kickback Statute is a federal law (codified at 42 U.S.C. §1320a-7b.1395nn) that prohibits healthcare providers from giving, or taking, bribes and kickbacks in exchange for referring Medicare patients for other medical services. Like the related Stark Law, the purpose of the Anti-Kickback Statute is to make sure doctors make referrals of Medicare and Medicaid patients that are in the patients’ best interest, rather than the best interest of the doctors’ own wallets. The law discourages doctors from making referrals for medically unnecessary or inappropriate services and, in the process, it reduces fraud on the government.

Specifically, the law prohibits the willful solicitation or receipt of remuneration in return for referrals of patients for services for which payment may be made in whole or in part under Medicare or Medicaid. The law also bars any offer or payment of remuneration to induce such referrals. “Remuneration” may be direct or indirect, and courts applying the Anti-Kickback Statute have interpreted the term broadly to mean “anything of value.”

Kickback and bribes come in all varieties. Some are obvious, like doctors who accept cash or untraceable gift cards in exchange for referrals. (Yes, this really happens). Others are more subtle. For instance, it could be an illegal kickback if a hospital gives a doctor free or reduced rent in exchange for the doctor’s “unofficial” agreement to refer patients to the hospital.

Medicare regulations provide for several, often confusing, exceptions to the “remuneration” rule. If you suspect a violation of the Anti-Kickback Statute, it is important to find a lawyer who has experience interpreting the Medicare regulations in order to evaluate your case.

Violations of the Anti-Kickback Statute may give rise to a claim under the False Claims Act. Whistleblowers who disclose violations of the Anti-Kickback Statute to the federal government may recover up to 25% or 30% of the fraudulent damages caused by the violations, depending on whether the federal government decides to intervene in the case.

To view the Anti-kickback Statute, click here.

Please Note: Rabin Kammerer Johnson provides these FAQs for informational purposes only, and you should not interpret this information as legal advice. If you know about government fraud and want advice as to how the law might apply to the specific facts and circumstances of your case, please click here to contact one of our attorneys.