Stark and Fraud & Abuse
Twenty years after the federal Medicare and Medicaid programs changed healthcare fundamentally in the 1960s and early 70s, Congress began passing laws targeted at perceived abuses of these programs by medical providers and suppliers.
About Anti-Kickback and Stark Law
The Medicare Anti-Kickback Statute and the Physician Ethics and Referral Law (commonly known as the “Stark law”) are the chief weapons in the government’s enforcement arsenal. However, Congress and executive branch regulators have implemented a variety of other “fraud and abuse” laws and regulations that outlawed what are considered good business practices in other industries, including discounts to customers to increase business and incentivizing employees to control and reduce expenses.
How the Laws Affect Healthcare Providers
Healthcare providers face a veritable army of taxpayer funded auditors, investigators, and prosecutors charged with enforcing these laws and regulations, including the Department of Justice and the Office of Inspector General of Centers for Medicaid and Medicare Services (CMS).
Anti-Kickback Statute can become a trap for the most well intentioned healthcare providers.
More recently, private attorneys have also targeted healthcare providers through whistleblower suits designed to take advantage of laws that allow private parties and their attorneys to achieve huge recoveries through private litigation against healthcare providers. When they choose to do so, government enforcement agencies may join in these suits as well.
Wise Carter’s Approach
The healthcare lawyers at Wise Carter understand that fraud and abuse laws and billing rules can be a trap for the unwary, at least as often as they target actual and intended wrongdoing.
The healthcare lawyers at Wise Carter regularly assist clients in constructing contractual arrangements to avoid Anti-Kickback and Stark violations. The following business arrangements, among others, must be structured correctly in order to avoid “automatic” Stark violations:
- Physician leases
- Services contracts
- Recruiting agreements
- Employment agreements
Wise Carter’s Stark and Fraud & Abuse Legal Services
Wise Carter attorneys are familiar with and regularly work with this complex set of federal laws and regulations. These laws impact how health care providers and others working within the healthcare industry must structure their potential business transactions as well as how they present their claims to federal and state payers in order to comply with the Stark law and federal fraud and abuse laws.
Our team also provides day-to-day compliance counseling for healthcare clients who understand that a meal or social outing for a referral source can violate the Stark and Fraud and Abuse law as readily as a long-term contract. Our lawyers follow the almost constant changes in fraud and abuse laws and regulations to help our clients navigate the ever expanding risks they face each day.
Structuring Healthcare Transactions
Wise Carter healthcare attorneys regularly assist clients in structuring healthcare transactions and other arrangements to minimize exposure to the risk posed by Stark and the Fraud and Abuse laws.
Wise Carter attorneys regularly advise a wide range of healthcare providers on how best to structure such business transactions and arrangements and how to manage and order their operations in order to avoid violation of these laws.
Internal Audits and Investigations
In addition to this preventative counseling, Wise Carter attorneys assist clients with internal audits and investigations of potential violations of the Stark law and fraud and abuse laws and in taking necessary remedial action, including self-reporting when appropriate.
Wise Carter’s Experience
Our experience includes:
- Structuring preventative measures
- Internal investigations and compliance reporting
- Defending healthcare providers in government investigations
- Whistleblower litigation involving the federal and state False Claims Act, the Medicare Anti-Kickback Statute, the Stark law and other civil and criminal statutes
Contact Wise Carter
For more information on legal services for Stark Law & Abuse matters, please contact one of the attorneys below.