Federal and state law both regulate healthcare patient referrals. Engaging in prohibited practices can result in criminal penalties such as jail time and fines. These laws are complex and frequently overlapping.
Federal law prohibits healthcare professionals from “knowingly and willingly” receiving, offering, soliciting, or paying “renumeration” to induce referrals that will be reimbursed by federal healthcare programs. Violation of this statute is a federal crime for which penalties include fines, jail, and exclusion from participation in federal healthcare programs.
Florida law also prohibits facilities that accept Medicare and Medicaid from patient brokering and kickbacks. The penalty for violation can include up to five years in prison and up to $20,000 in fines per count.
Self-Referrals are prohibited by the Stark Law
Self-referrals by physicians are prohibited under both state and federal law. The “Stark Law” prohibits this practice at the federal level, while the Florida Self-Referral Statute operates at the state level.
The Stark Law, named after its sponsor, U.S. Congressman Pete Stark, prohibits “self-referral” by physicians. “Self-referral” occurs when a physician refers a patient to a medical care facility for a “designated health service” where the physician, or a member of his or her immediate family, has a financial relationship with that facility. The law prohibits facilities from receiving payment under Medicare or Medicaid for services provided under such referrals.
Violation of Stark can lead to severe penalties. Penalties can include a denial of payment, refund of payment, an imposition of a $15,000 per service civil monetary penalty, and an imposition of a $100,000 civil monetary penalty for each arrangement considered to be a violation.
If you are being investigated or have been charged with committing any of these prohibited practices, you should not delay consulting with an attorney. The attorneys at Rosenberg Law, P.A. are knowledgeable about these prohibited practices and how to defend against investigation and charges. Rosenberg Law, P.A. also helps healthcare providers establish policies to ensure compliance with these statutes. Any physician considering an investment in an outside entity to which self-referral or kickbacks might become an issue should first consider speaking to a healthcare attorney.