It is a violation of federal law to offer, pay, or receive kickbacks for referrals of Medicare and Medicaid patients.  42 U.S.C. § 1320a-7b(b).  This is known as the Anti-Kickback Act.  Kickbacks can include a wide array of remuneration beyond cash exchanged for referrals.  They encompass the purchase, lease, or provision of any goods or services exchanged for referrals.

Under another federal law, the Stark law, it is also a violation for a physician to refer a patient to a facility if they have a financial relationship with that facility.  42 U.S.C. § 1395nn (a)(1), (h)(6).

Compliance with these laws is an express condition of payment under Medicare and Medicaid programs.  Providers who falsely certify compliance with these rules may be held civilly liable to whistleblowers and the government under the False Claims Act (FCA)See United States ex rel. Thompson v. Columbia/HCA Healthcare Corp., 125 F.3d 899, 902 (5th Cir. 1997); see also United States ex rel. Hopper v. Anton, 91 F.3d 1261, 1266 (9th Cir. 1996).

If you have uncovered Medicare and Medicaid fraud, contact the whistleblower attorneys at Miller Law Group today for a free consultation or call us at (919) 348-4361.

Additional Resources: 

Whistleblower’s Award in False Claims Act Case

Whistleblower Protection Under the False Claims Act