Cheronis & Parente LLC

Criminal Defense Blog

ON BEHALF OF CHERONIS & PARENTE LLC   /   January 27, 2023

3 Medicare fraud and abuse laws of importance to physicians

Medicare fraud costs the federal government billions of dollars each year and investigating this kind of fraud involves several government agencies.

Here are three examples of fraud and abuse laws that apply to physicians.

1. The False Claims Act (FCA)

The goal of the FCA is to protect the federal government against overcharging. The Act imposes civil liability on anyone who “knowingly submits or causes the submission” of a fraudulent claim with respect to a government-run healthcare program. Penalties for violating the FCA include payment of three times the value of the false claim.

2. The Physician Self-Referral Law (Stark Law)

The Stark Law forbids doctors from referring Medicare beneficiaries to a lab, office, hospital or other entity in which they have a financial or personal interest. However, a doctor may refer a patient to another physician in the same practice. Violation of the Stark Law may result in the payment of fines, repayment of false claims and civil money penalties of up to $24,478 per referral.

3. The Anti-Kickback Statute (AKS)

Per the AKS, it is unlawful to “knowingly and willfully offer, pay, solicit, or receive” remuneration to induce or reward patient referrals regarding an item or service reimbursable by a federal healthcare program. In addition to money, remuneration can mean luxury items, vacations, or free or discounted services. Violators face penalties up to three times the value of the kickbacks received plus fines of up to $100,000 per kickback. Penalties also include the potential for imprisonment and exclusion from participating in federal healthcare programs. It is not necessary for the federal government to prove financial loss or patient harm in showing that a physician violated the AKS.

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