From prescribing essential medications to performing complex procedures, doctors carry the weight of high expectations. However, in the modern era, physicians also must be wary of the complex relationship between ethical medical practices and smart business decisions.
All too often doctors and other health care providers with good intentions find themselves facing charges of medical fraud. In many cases, providers may not have been aware of how their actions might have led to potential prosecution.
The federal Anti-Kickback statute prohibits providers from knowingly offering, soliciting, paying or receiving direct or indirect remuneration for the sake of patient referrals or to generate economic gain through reimbursement by federal and/or state health care programs. To avoid kickback charges, doctors should be careful of any transactions that involve payment for items or services not related to direct medical care to a patient.
The Stark Law is another federal statute that seeks to prevent self-serving practices. Under this law, physicians cannot refer patients to services that might benefit themselves or close family members financially.
False claims allegations
Providers must be especially careful when billing federal programs, such as Medicare or Medicaid. Falsified or unjustified claims can result in severe penalties under the U.S. False Claims Act. Examples of prohibited practices include ordering unnecessary tests, billing for unrendered services or supplies and misrepresenting the date, location or provider of services.
Medical professionals should know that, regardless of amount of money involved, fraud charges can result in serious personal and professional consequences. In addition to potential loss of medical licensure and steep monetary penalties, practitioners may face termination from public and private insurance contracts, loss of professional reputation and severe criminal sanctions.