What is the Federal Anti-Medical Benefit Kickback Statue or The Medicare and Medicaid Fraud and Abuse Statute? This federal criminal law in the United States is designed to remove the corruption found within healthcare by prohibiting anyone from giving and receiving any type of remuneration to direct patient referrals to or away from particular healthcare providers, or for buying certain healthcare services. While is acceptable to reward those who refer business to you, paying for referrals is a crime. This law was first enacted as a means to combat fraud and abuse in the Medicare and Medicaid Programs by Congress in 1972, which was then added as an amendment to the Social Security Act. As a result of these bribes, physicians would typically provide patients with medically inappropriate goods and services that are costly, medically unnecessary, and of poor quality. According to the Anti-Medical Benefit Kickback statute (AKS), any type of payment or financial benefit to a physician will be considered as remuneration (the exchange of goods such as money, donations gifts, and even consulting fees) and will be open to prosecution. A violation of AKS may result in a physician facing penalties of up to $50,000 per kickback plus three times the amount of remuneration. However, there are safe harbors built in place to protect certain payment arrangements whose purpose is not to induce referrals that violate AKS. Overall, the AKS serves as a vital tool that protects patients from the corrupt medical decisions of physicians induced by greed.
Citations:
“Fraud & Abuse Laws.” Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services, 1 Sept. 2021, oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/.