Tag: Anti-Kickback Statute

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Stark + AKS Final Rules

The final rules for changes to the Stark Law and Anti-Kickback Statute (healthcare fraud & abuse laws) have been published and go into effect on January 19, 2020. Of course, health lawyers love this stuff, but it could impact other practice areas too.

Transaction attorneys, you already know to be very careful if your transaction or arrangement, in any way, involves a hospital, doctor, or any other healthcare provider or entity. Even if your deal does not involve a healthcare provider, but could impact reimbursement by any federal program, these statutes may be implicated.

Litigators, these statutes can apply to your cases too. If your case involves one of these improper payments or an improper business structures, you might have a contractual avoidance theory available to you, if you’re the defendant, or an additional claim of fraud, if you are the plaintiff.

The key point is that these statutes can apply in ways that don’t seem immediately obvious.

Source: Stark + AKS Final Rules

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Houston physician sentenced to prison for $17M billing fraud

Yolanda Hamilton, MD, was found guilty by a federal jury of participating in a Medicare scheme that involved signing false “plans of care” and other medical documents for home health services that were used to submit fraudulent claims to Medicare. She allegedly received $30,000 in kickbacks during the four-year scheme. Prosecutors alleged that Dr. Hamilton and her co-conspirators submitted more than 2,500 fraudulent claims to Medicare, according to the Houston Chronicle.

Source: Houston physician sentenced to prison for $17M billing fraud

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Two charged in prescription and kickback scheme

An 11-count indictment unsealed on Friday charges former Kindred Home Health employee Amber Price, 37, and Christopher Cruz, 46, owner of a medical marketing business, CP Cruz Management Group, LLC (Cruz), with one count of conspiracy to violate the federal anti-kickback law.

Under the alleged scheme, Price and Cruz would create fraudulent prescriptions using actual hospital patient data. They would either forge the physicians’ signatures on the prescription forms or use pre-signed or photocopied forms. Price and Cruz would then provide fraudulent prescriptions to pharmacies or labs for submission to Medicare and private payors for reimbursement. When the pharmacies and labs got reimbursed, they would pay a percentage of the reimbursement to Price and Cruz.

The submission of false prescriptions is a violation of the civil False Claims Act. No doubt, Price and Cruz were charged with conspiracy to violate the Anti-Kickback Statute in order to impose criminal liabilities on top of the civil penalties under the FCA.

Source: Two people charged in connection with health care fraud scheme, officials say