It’s not unusual for laws related to healthcare and the conduct of medical professionals to overlap somewhat. In the case of the Stark Law and Antikickback laws, it’s easy to see why someone would be confused about the intent and the scope of each of those laws. If allegations of actions that violate any of these laws arise, it pays to understand how they differ. Here are some points to keep in mind while working with a lawyer to resolve the current issue.
What is the Stark Law?
What is generally referred to as the Stark Law is actually a collection of laws aimed at preventing patient referrals for the purpose of generating some type of personal gain. Those laws prohibit a physician from referring an existing patient to another medical entity in which that physician has some sort of financial interest and would stand to make some amount of money by having that patient utilize the services provided by that entity.
For example, a general practitioner may be a silent partner in a facility that offers eye exams and other forms of eye care. The practitioner recommends that a type 2 diabetic patient have an eye exam once a year and then provides a referral to that specific facility, even going as far as to schedule an appointment for the patient. In this scenario, the physician ultimately profits from providing general care directly and a form of specialized care indirectly.
The terms of these laws also extend to what is classed as immediate family. This means if the physician refers a patient to a specialist who happens to be an immediate family member, a violation has taken place.
How About Antikickback Laws?
Antikickback laws are also designed to prevent financial remuneration in exchange for inducing someone to utilize a specific healthcare service. That includes soliciting on behalf of that service and receiving something of value when a patient makes use of that service because of the solicitation. Rewards programs, cash under the table, and the receipt of anything of monetary value would all be considered a type of kickback.
What Penalties Can Result From Violating Any of These Laws?
Violations of Stark or Antikickback laws and statutes all carry some type of civil penalty. Both may involve what is known as civil money penalties. These are fines related to the events that transpired and are usually applied on a per violation basis. If some type of kickback can be proven, the CMP could be as much as $50,000.00 USD per violation. With a Stark violation, it could mean a penalty per violation of as much as $15,000.00.
Civil actions can also involve having to repay whatever financial gain was made from the referral. In addition, program exclusions may take place along with a series of fines.
If a kickback violation is claimed, there are also criminal repercussions that could occur. Depending on whether or not those claims can be substantiated, the client could face fines of up to $25,000.00 for each violation along with jail time of up to five years for each confirmed event.
In both cases, the accused party is open to civil litigation. This means that a patient who later finds out that the referring medical professional received some type of monetary gain from the referral has the right to seek damages through the court system. This is especially true if those services ultimately prove to be of no value in terms of treating the patient.
Why Legal Representation Matters
An allegation of receiving kickbacks or of making referrals in order to personally profit can do more than lead to various type of fines and possibly time spent in jail. There is also the potential to damage the reputation of the medical professional significantly. Should the professional be found guilty as charged, there is a real possibility of current patients choosing to seek services elsewhere. Others who may be looking for a primary care physician or a specialist will also be more likely to focus the search on other professionals who have not engaged in this type of activity.
A lawyer who handles cases involving Stark violations and kickback cases will understand how to evaluate all the facts and craft a reasonable defense. This improves the odds of all relevant information being presented to the court and ensuring that the client does receive a fair and balanced judgment.