The Anti–Kickback Statute and the Stark Law are two important pieces of legislation that are designed to protect patients from fraudulent medical practices and protect taxpayer dollars from being wasted on unnecessary medical care. While these two laws have similar goals, they are actually quite distinct and have different implications for medicare fraud enforcement and the whistleblowers who bring these cases to light.
The Anti-KickBack Statute
The Anti–Kickback Statute (AKS) is a federal law that was passed in 1972 as part of the Social Security Act. This law was designed to prevent healthcare providers from offering or receiving illegal kickbacks for referrals of patients, services, or items covered by Medicare or Medicaid. The purpose of the AKS is to ensure that healthcare providers are making decisions based on the best interest of their patients, rather than a financial incentive. The AKS prohibits any kind of payment, whether directly or indirectly, that is intended to induce a referral or to reward a referral that has already taken place. The AKS also prohibits any kind of arrangement that has the potential to influence the decision of a healthcare provider to refer a patient to a particular provider.
The Stark Law
The Stark Law, which is also known as the Physician Self–Referral Law, was passed in 1989 and is named after Congressman Pete Stark. This law is designed to prevent healthcare providers from referring their patients to any entities with which the provider has a financial relationship. The purpose of the Stark Law is to ensure that healthcare providers are making decisions based on the best interest of their patients, rather than a financial incentive. The Stark Law prohibits any kind of referral by a physician that is made in exchange for a financial benefit. This includes referrals for any kind of medical service, item, or procedure that is covered by Medicare or Medicaid.
Which Law Applies To Whistleblower Claims
Although the Anti–Kickback Statute and the Stark Law both have similar goals, there are several important distinctions between the two, although both or either may apply to claims brought by whistleblower seeking to combat medicare fraud. The most significant difference between the two is the scope of the prohibited activities. The Anti–Kickback Statute applies to any payment, whether directly or indirectly, that is intended to induce a referral or to reward a referral that has already taken place. In contrast, the Stark Law applies only to referrals made by a physician that is made in exchange for a financial benefit. Another key difference between the Anti–Kickback Statute and the Stark Law is the penalties for violations. The Anti–Kickback Statute prohibits a variety of activities and violations can result in criminal and civil penalties. Penalties for violations of the Anti–Kickback Statute can include fines of up to $50,000 per violation and up to five years in prison. The Stark Law also carries significant penalties, including fines of up to $15,000 per violation and exclusion from participation in the Medicare and Medicaid programs. Ultimately, the Anti–Kickback Statute and the Stark Law are two important pieces of legislation that are designed to protect patients from fraudulent medical practices and taxpayers from waste . While these two laws have similar goals, there are several key differences between them. It is important for whistleblowers who have witnessed or uncovered medicare fraud to consult with attorneys knowledgeable about the differences between the Anti–Kickback Statute and the Stark Law in order to ensure that the best case for recovery can be made.
At Price Armstrong, our qui tam whistleblower attorneys have extensive experience litigating medicare and anti-kickback fraud under the False Claims Act. If you have information about potential fraud against the government, you may have a valuable claim as a whistleblower. Contact us today for a free initial consultation and review of your case.
