In this article, Westfall Sellers` experienced healthcare fraud prevention lawyers will help you understand each law and the differences, and advise you on when to find a Stark Law lawyer. The Stark Law and the Anti-Bribery Act are very similar, with some important differences. The anti-bribery law covers referrals for all services provided by anyone, including doctors or pharmaceutical companies. Conversely, stark law only applies to physician referrals and covers an established list of “designated health services” (DHS). One of the main differences between the Stark Law and the AKS is the type and degree of sanctions associated with each law. Given that the AKS provides for civil and criminal penalties, and that the intention to violate this law must be demonstrated, the consequences are more serious than those of the Stark Law. AKS civil penalties include liability under the False Claims Act, civil fines (CMP) and exclusion from the program, up to CMP$50,000 per violation, and a civil assessment of up to three times the amount of the bribes. When AKS deals with criminal sanctions, the consequences include fines of up to $25,000 per violation and up to five years` imprisonment per violation. Like CMS, the OIG has created three safe havens, with each safe harbor offering a sliding scale of flexibility based on the level of financial risk taken by participants (with higher financial risk providing greater flexibility).
All three shelters protect in-kind benefits (i.e., non-monetary clearing, but monetary compensation, is only protected by the significant financial downside risk and the total financial risk of the Safe Harbor (a significant difference from the Stark Act exception, which protects both monetary and non-monetary compensation under the 3 exceptions, regardless of the level of financial risk taken by participants). While these laws are similar in how they treat compensation in relation to inappropriate transfers, there are several differences between them: A Safe Harbor describes various payment and business practices that, while they would typically result in a violation of the anti-bribery law, are not treated as a criminal offense under the law. There are many Safe Harbor agreements, and some of the most commonly used Safe Harbor agreements include: Stark Act violations most often come from indemnification agreements rather than property agreements. Some examples are conspiracies between entities and doctors for laboratory services. Providers and doctors were also held responsible for compensating doctors for cancer drugs. The AKS was amended to make a violation of the anti-bribery law a “false or fraudulent” claim under the False Claims Act. 42 U.S.C§ 1320(a)-7b(g). The Federal Anti-Bribery Act (AKS) (see 42 U.S.C§ 1320a-7b.) is a criminal law that prohibits the exchange (or offer to exchange) of anything of value to induce (or reward) referrals to businesses that can be reimbursed by federal health programs. Examples of prohibited bribes include receiving financial incentives for referrals, free or very low rents for offices, or excessive remuneration for medical leadership positions. Other bribes include the cancellation of quotas, either routinely or selectively on a case-by-case basis.
The Centers for Medicare and Medicaid Services (CMS) claims that bribes have led to overuse and increased costs of health services, corruption in medical decision-making, distraction of patients from valid services or therapies, and unfair and uncompetitive service delivery. Possible penalties for AKS violations include: fines of up to $25,000, up to five years in prison, and exclusion from Medicare and Medicaid care programs. There can be confusion when one understands the differences between the anti-bribery law and the doctors` self-orientation laws or the Stark laws. While both aim to limit the cost and corruption of medical decision-making, there are important differences between the two. One of the other key differences is that the Stark Act is limited to Medicare or Medicaid, and the ACK Act applies to all publicly funded health care programs. Penalties for fighting bribes may include criminal sanctions such as jail time, while the highest penalty for Stark violations is civil penalties such as fines and liability under the False Claims Act. Penalties for Stark violation or Medicaid billing fraud can be severe. Unlike the anti-bribery law, the Stark law is a strict liability law.
This means that there is no need to punish proof of intent, even if it is an accident. Instead of repeating the long definitions provided by CMS, an example that uses each of these terms is useful. One could imagine a hospital-doctor compensation agreement where the hospital encourages a group of doctors to improve the quality of care for patients undergoing lower limb replacement, with the aim of reducing relapses by paying the group of doctors for each post-discharge meeting in which one of its doctors participates. The value-based enterprise (VBE) consists of the hospital and the group of physicians (whether the hospital and the group of physicians form or instead create an informal affiliation). The value-based agreement is the remuneration agreement between the hospital and the medical group. The value-based goal is to improve the quality of care for patients with joint replacement in the lower limbs. Values-based activity is participation in meetings after relief. The AKS requires proof of actual illegal intent. The Stark Act is a strict liability law – no intention needs to be proven. Under the AKS, the physician cannot pay, offer, request or receive anything of value to refer patients to a federal health program or to generate business for a federal health program.
This is in contrast to stark law, which prohibits a physician from referring a patient to a health care facility in which they have a financial interest, unless they fall under one of the exceptions set out in the law. There is a lot of confusion between the federal anti-bribery law and the Stark law, as both laws deal with compensation related to inappropriate transfers. However, there are fundamental differences between the two laws. While both laws are intended to eliminate misconduct in health care, they each have important differences. Although the two laws cover illegal financial arrangements, there are important differences between them. The amount of the award also depends on the role of the government in the dispute. Under the FCA, the government has the right to intervene in the case and is given time to decide whether to take over the case. If the case is taken over by the government, the whistleblower can receive between 15% and 25% of the funds recovered from the government, depending on his involvement in the government`s efforts and the quality of the information he provides […].