Avoiding Anti-Kickback Violations: Tips for Physicians

Though hospitals themselves are under the most scrutiny to have compliant financial relationships with physicians, it is nonetheless important for physicians to be aware of federal fraud and abuse laws.

Avoid violating the Anti-Kickback Statute with the following tips:

  • Don't receive payments from a hospital unless you have a contract with a payment rate negotiated in advance. Unless you have a contract which spells out the nature of the relationship and the services you provide the organization, you should not receive any payments for services. Not having a personal services agreement (or having an expired agreement) violates AKS.
  • Don't accept compensation or gifts from hospitals unless you know they are under the annual limit and being tracked by the hospital for compliance purposes. For 2014, the non-monetary compensation limit is $385 per year. In 2015, it's $392. It's not hard to reach this number. Keep in mind that if a hospital gives you a gift or entitlement worth money that is not given to the entire medical staff, this gift must be tracked with other gifts and the total cannot exceed the maximum. If it does, you will be responsible for paying back the facility.
  • Don't leverage your referral position during negotiations or conversations with a hospital. It is unwise to suggest that you can increase business for a hospital during negotiations. Though this could seem like a small business strategy for you, in reality you are offering and suggesting that the hospital reward you for referrals, which is explicitly forbidden in AKS and breaking the law.
  • Never threaten to stop referring patients to a hospital during a negotiation. Likewise, threatening to stop sending referrals to an organization in retaliation infers that you have been referring patients to the facility for money. Don't put yourself or your administrator in this position.
  • Do not accept payments or remuneration of any kind for referrals. Make sure that all payments a hospital makes to you are within fair market value. Even if the administrator isn't concerned about fair market value, it's important that you be concerned. If you or the hospital gets caught with payments above fair market value, if you are convicted you will most likely lose eligibility to be reimbursed by all government programs, not to mention be thrown in jail for up to five years. If you need help ensuring that your payments are truly fair market value, contact us to obtain data for your specialty.

allison

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