Healthcare providers afford an invaluable service to society. Unfortunately, due to certain “bad apples” who take advantage of the system, the Federal and state governments have enacted certain legislative anti-fraud measures. Those anti-fraud measures not only act as a deterrent for the wrongdoers but have the adverse effect of making things difficult for the physicians and other healthcare providers whose intent is to provide fair and effective medical services to society. At Cohen Legal Group, we assist providers in navigating through some of these legal and administrative barriers that hinder their ability to provide the medical treatment that their patients deserve and expect. However, we also believe that healthcare providers must have a basic understanding of some of these laws and regulations. Therefore, we will provide a brief synopsis of some of the crucial laws which healthcare providers tend to encounter.
- THE FALSE CLAIMS ACT
The False Claims Act protects the federal government from being overcharged for medical services or billed for unnecessary medical services. It places a responsibility on the healthcare provider to avoid submitting bills to Medicare or Medicaid that it knows, or otherwise should know, are “false or fraudulent”. These false or fraudulent submissions may encompass bills that are inflated or not medically necessary in the mind of the government. Specific intent is NOT required. These claims may result in fines of as much as three times the losses to Medicare or Medicaid in addition to an $11,000.00 fine per claim.
- ANTI-KICKBACK/FLORIDA PATIENT BROKERING STATUTE
Both the Federal and state governments have enacted criminal Anti-Kickback statutes that prohibit healthcare providers from paying “referral fees” to reward patient referrals from other providers. This law makes kickbacks and referral fees for medical and healthcare services a crime and covers those providers who pay the kickbacks as well as the recipient of the kickbacks. These kickbacks may cover anything from monetary remuneration to expensive gifts. However, there are many safe harbors that protect certain payments and business practices. Florida has enacted its own Patient Brokering Statute, which is presently in a constant state of change. Due to recent amendments, as well as proposed amendments presently being debated in the House and Senate, there is a new and constantly evolving level of uncertainty as to the exceptions for certain business practices that have been regarded as the norm for medical practices in Florida.
- THE STARK LAW
The Stark Law or Physician Self-Referral Law prohibits healthcare providers from referring “designated health services” to entities in which the referring provider, or immediate family member, has a financial interest. The list of designated health services is long but there are certain exceptions to the prohibition. As in the False Claims Act, specific intent to violate the law is NOT required to subject a healthcare provider to fines for violating the Stark law. These fines may range from monetary fines to exclusion from participation in Federal healthcare programs.
The mandates of these laws and regulations place burdens on medical providers that make it difficult for them to expand their practices for the benefit of their patients. We can assist healthcare providers in navigating through these laws as they set up their respective healthcare practices. If you have any questions, please call Cohen Legal Group at (954) 617-6500.