“Anti-kickback statue” and “Stark” violation

Sample Solution

      The Anti-Kickback Statute (AKS) and the Stark Law are two federal laws that prohibit certain types of financial relationships between healthcare providers and entities that supply healthcare goods and services. The AKS prohibits the offer, payment, or receipt of remuneration (anything of value) in exchange for referrals of patients or the generation of business for certain healthcare items or services. The Stark Law prohibits physicians from referring Medicare or Medicaid patients to entities with which they have a financial relationship, unless an exception applies.

Full Answer Section

      In the scenario you described, the pharmaceutical rep is offering the physician tickets to a major sporting event in exchange for the physician purchasing all of their drugs. This would be a violation of the AKS because it is considered remuneration that is intended to induce or reward patient referrals. The physician would be essentially paying for the tickets with their own patients' referrals. The Stark Law also prohibits this type of arrangement, because the physician would be referring patients to the pharmaceutical rep in exchange for a financial benefit. However, there is an exception to the Stark Law that allows physicians to accept gifts of nominal value, such as tickets to sporting events. The value of the tickets in this scenario would likely exceed the threshold for nominal value, so the Stark Law would also be violated. The penalties for violating the AKS or the Stark Law can be severe. Individuals who violate the AKS can be fined up to $25,000 per violation and imprisoned for up to five years. Entities that violate the AKS can be fined up to $50,000 per violation. Individuals who violate the Stark Law can be excluded from participation in Medicare and Medicaid. Therefore, if the physician in this scenario accepts the tickets from the pharmaceutical rep, they would be violating both the AKS and the Stark Law and could face significant penalties. Here are some additional things to keep in mind about the AKS and the Stark Law:

• The AKS applies to all federal healthcare programs, including Medicare, Medicaid, and Tricare.
• The Stark Law only applies to Medicare and Medicaid.
• The AKS and the Stark Law are strictly enforced by the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS).
• There are a number of exceptions to the AKS and the Stark Law, but it is important to be aware of the rules before entering into any financial arrangements with a healthcare provider or supplier.

If you have any questions about the AKS or the Stark Law, you should consult with an attorney who specializes in healthcare law.