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Qui Tam / False Claims Act: Anti-Kickback Law

The Anti-Kickback Statute is a federal criminal statute that prohibits physicians from giving another healthcare provider anything of value in exchange for a referral of a patient covered under a federal healthcare program, such as Medicare, Medicaid, Tricare, or others. Violation of this statute can result in not only monetary fines but also criminal penalties, yet it is one of the top healthcare fraud laws that physicians and hospitals violate on a regular basis. If you believe you were referred to a physician as part of a monetary or other valuable exchange between your physician and another healthcare provider, contact an experienced qui tam attorney at Willoughby Brod LLP today to report the Anti-Kickback Statute violation and learn how our attorneys can help with your whistleblower case.

The California False Claims Act

After the federal False Claims Act (FCA) was enacted in 1986, California enacted its own version of the Act called the California False Claims Act (CFCA). Modeled after the FCA, the CFCA is very similar to the FCA with the exception of a few minor differences.

The purpose of the CFCA was to create a cause of action against individuals and companies that knowingly submit false or fraudulent claims for payment, misappropriate public property, or avoid paying what it owes to the state of California or to local governments within the state. Violation of the CFCA is a civil offense and can result in fines of up to three times the actual harm to the state, plus a fine of $5,500 to $11,000 for each violation of the CFCA.

Qui Tam Provision

Under the CFCA’s qui tam provision, a whistleblower is permitted to file a claim under the Act. A whistleblower is an individual who informs on another individual or organization engaged in illegal conduct. Once a whistleblower files his or her lawsuit, which is kept under seal, the Attorney General or other prosecuting attorney may conduct its own investigation into the claim and may choose to intervene in the whistleblower’s lawsuit. If the Attorney General or local prosecuting attorney successfully prosecutes the case, the whistleblower may receive a portion of the reward, up to 33% in some cases. Since whistleblowing cases are quite complex, it is advisable to contact an attorney to assist you in filing your whistleblower claim.

Anti-Kickback Statute

The goal of the Anti-Kickback Statute is to prevent physicians and hospitals from referring patients to other healthcare providers in exchange for something of value, whether that is cash or something else. This statute only applies to patients covered under a federal healthcare program, such as Medicare, Medicaid, Tricare, or another federally funded healthcare program.

Exceptions

When keeping an eye out for violations of Anti-Kickback Law, it is important to remember certain safe harbors that exist for physicians and hospitals under the statute. Specifically, if you notice any of the following payment practices that would typically appear to be a violation of the Anti-Kickback Statute, know that they fall into the safe harbors provision and do not actually constitute a violation of the statute:

  • Investment interests: A payment that constitutes a return on an investment interest, such as a dividend or interest income, is not a violation of the Anti-Kickback Statute as long as certain provisions are met.
  • Property leases: A payment made by a lessee to a lessor for use of the premises is not a violation of the Anti-Kickback Statute.
  • Equipment rentals: A payment made by a lessee to a lessor for use of equipment is not a violation of the Anti-Kickback Statute.
  • Personal services and management contracts: A payment made by a principal to an agent as compensation for services performed by the agent does not constitute a violation of the Anti-Kickback Statute.
  • Sale of a practice: A payment made by one practitioner to another as payment for purchasing the practice does not constitute a violation of the Anti-Kickback Statute.

To see a complete list of Anti-Kickback safe harbors, click here.

Contact Our Qui Tam/False Claims Act Lawyers Today

Now that you are aware of the function and purpose of the Anti-Kickback Statute, you may be able to detect violations to the Anti-Kickback Statute from your physician or healthcare provider. If you believe your physician is acting in violation of the Anti-Kickback Statute, contact one of the experienced qui tam lawyers at Willoughby Brod LLP today so we can get started on your whistleblower claim. Contact us online or at (800) 427-7020 to schedule your confidential consultation and find out how we can help.

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