In a recent post, we mentioned the Anti-Kickback Statute as being one of the federal statutes under which physicians and other health care providers can face penalties for fraudulently billing. As we mentioned, the Anti-Kickback Statute is one of the federal statutes that provides for the possibility of criminal penalties. To be charged under the statute, though, the defendant must have had the requisite intent. The defendant, specifically, must have knowingly submitted a false health care claim.
In cases where the government does not believe it can prove criminal intent, it is still able to pursue a civil prosecution under the statute. Proving intent is a critical for prosecutors, since their ability to obtain criminal penalties for violations of the statute depends on it. Civil penalties under the statute can still be costly, to be sure, though, and physicians do well to be conscientious about the referral arrangements they enter into.
Monitoring of physician fee arrangements is apparently something that authorities are taking more and more seriously. Earlier this month, the Health and Human Services Office of Inspector General—which enforces the Anti-Kickback Statute—released a fraud alert that some say indicates that the federal government is increasing investigations of kickback schemes, particularly the role individual physicians play in these schemes.
One important point to remember about physicians is that they are frequently contacted by entities regarding referral arrangements and it does can happen that a physician doesn’t examine an arrangement enough prior to participating. In such cases—and in any case where a physician gets wrapped up in an illegal referral scheme—it is important to work with an experienced attorney to minimize penalties.