Kickbacks & Stark Billing Lawyers: Your Best Defense Against Complex Healthcare Regulations
Navigating healthcare regulations can be tricky for providers. Two major laws—the federal physician self-referral prohibition (known as the Stark law) and the federal Anti-Kickback Statute—aim to prevent fraud and abuse. But their complexity leaves providers vulnerable to unintentional violations.
That’s where experienced Kickbacks & Stark Billing lawyers can help. They understand these laws inside and out. They know how prosecutors interpret them, where the gray areas are, and what defenses work. With an attorney’s guidance, providers can avoid penalties, recoup payments, and protect their business.
What is the Stark Law?
The Stark law prohibits doctors from referring Medicare patients to healthcare facilities they or their family have a financial interest in. This includes things like ownership, investment, or compensation deals. The idea is to remove financial incentives that could influence medical decisions.
There are exceptions, like physician services in the same building. But they’re narrow. Facilities can’t bill Medicare for services that violate Stark. And penalties for running afoul can be stiff—up to $24,253 per claim.
What is the Anti-Kickback Statute?
This federal law bans paying or receiving anything of value to induce or reward referrals for federally-funded healthcare services. Things like free rent, excessive compensation, and underpriced equipment fall under its umbrella.
Anti-kickback violations are felonies punishable by fines up to $100,000 and five years in prison. Providers who engage in them can also face exclusion from federal programs.
Why are These Laws so Complex?
The Stark law and Anti-Kickback statute use broad language. Terms like “fair market value” and “takes into account” are open to interpretation. There are also numerous technical requirements and exceptions. This ambiguity allows prosecutors to pursue many different arrangements.
But it also means well-intentioned providers may stumble into violations. In particular, newer models like accountable care organizations don’t fit neatly into the laws’ frameworks.
How Can a Lawyer Help with Kickbacks and Stark Violations?
Experienced attorneys understand where the gray areas are. They can help providers:
- Structure agreements that comply with exceptions and safe harbors.
- Develop defenses showing the arrangement doesn’t violate the law’s technical requirements.
- Avoid intent-based charges by demonstrating the provider acted in good faith.
- Get back payments deemed improper due to technical Stark issues.
- Negotiate settlements that minimize penalties and avoid program exclusion.
- Navigate the appeals process to reverse unfavorable rulings.
What Defenses Can Lawyers Use?
Lawyers have several options to defend providers or reduce penalties in kickback and Stark cases:
- No remuneration – Show no improper compensation changed hands.
- No intent – Demonstrate the provider didn’t knowingly violate the law.
- Technical errors – Argue violations stem from technical issues, not intentional abuse.
- Value was fair – Prove compensation was at fair market value.
- Arrangement doesn’t induce referrals – Show volume or value of referrals was not considered.
- Service qualifies for exception – Cite an exception like in-office ancillary services.
- Advisory opinion – Note CMS approved a similar arrangement.
Who Needs a Lawyer for These Issues?
Any healthcare provider entering into compensation arrangements or ownership deals should consult a lawyer. Counsel can help structure agreements that comply with kickback and Stark regulations from the start.
Providers who face audits or charges should also contact an attorney immediately. An experienced lawyer’s guidance can mean the difference between a crippling penalty and a manageable settlement.