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Understanding the Anti-Kickback Statute

On Behalf of | Feb 1, 2023 | Medicare & Medicaid |

Kickbacks are a normal part of many industries. In healthcare, however, kickbacks are unethical, illegal and potentially a threat to patient care.

The Anti-Kickback Statute addresses the problem of kickbacks in healthcare, while the safe harbor regulations provide limited exceptions to the law.

Explaining the Anti-Kickback Statute

The AKS prohibits healthcare providers from giving or receiving rewards, also called remuneration or kickbacks, in exchange for promoting goods and services payable by Medicare or Medicaid, such as drugs and healthcare services.

For example, a doctor might prescribe a medication to a Medicare patient and receive money from the pharmaceutical company for doing so. This provider is acting in violation of the AKS and committing Medicare fraud.

The AKS applies to patients as well. For example, a provider may not give free services or waive copays to encourage patients to use his or her practice. Providers can still waive fees for patients who can not afford to pay.

Understanding the impact of kickbacks

Physicians and other healthcare providers wield a significant amount of influence. Patients trust them to recommend the most effective treatments, services and drugs. When providers accept kickbacks, it can affect their ability to make sound decisions about patient care.

Accepting remuneration for referrals also creates an unfair competitive advantage for the company that is paying for business and can drive up Medicare and Medicaid costs.

Potential consequences of violating the AKS can include fines, criminal penalties or the termination of the practice’s Medicare contract.

For healthcare professionals, accepting or offering kickbacks is never a wise decision.