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In some industries, it’s not only legal to reward someone who refers business, it’s considered good form to do so. Healthcare is not one of those industries, however. It’s a crime for healthcare practitioners to take anything of value in return for a referral, order or prescription when the goods or services are paid for by Medicare, Medicaid or any other part of the federal government.

Many Detroit-area healthcare providers undoubtedly recall that in 2019, Beaumont Health agreed to settle allegations that it violated the Anti-Kickback Statute by making payments to physicians who made referrals to its William Beaumont Hospital in Royal Oak.

The health system was also accused of violating the Stark Law, or self-referral law, which prohibits hospitals from billing Medicare for services referred by physicians with whom the hospital has a financial relationship.

Beaumont Health agreed to pay $82.74 million to the federal government and another $1.76 million to the state of Michigan.

Another application of the Anti-Kickback law can be found in the recent settlement of the CareCloud Health case. The Florida-based developer of EHR (electronic health records) “agreed to pay $3,806,966.70 to resolve allegations that it paid unlawful kickbacks to generate sales of its EHR products,” th

Like other medical professionals, chiropractors are aware of the significant benefits to patients when health care is provided by a medically integrated practice.

“Medical errors are minimized, unnecessary tests avoided, prescription painkillers reduced,” chiropractor Jesse Cooper told the American Chiropractic Academy in 2019.

However, there are strict services and billing guidelines to be observed and potentially serious legal consequences when integrated practices are not set up properly, according to a recent article by chiropractor and medical compliance officer, Ray Foxworth.

He writes in the current issue of Chiropractic Economics that a multidisciplinary medical practice should assume that audits will take place and prepare accordingly.

Chiropractor Mark Sanna – who also authored a piece in CE – writes that medically integrated practices should “retain local legal counsel familiar with the group practice health care laws and regulations of the state in which the practice will be established.“

Sanna notes that “while successfully operating a MDP can be rewarding, those rewards can quickly disappear should the chiropractor and other professionals involved not adhere to the most stringent policies and procedures.”

Foxworth writes that medically integrated practices “must be aware” of the federal Anti-Kickback Statute that forbids he

The Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services Office of the Inspector General (OIG) recently released their final rules revisions of the Physician Self-Referral Law (the Stark Law) and the Anti-Kickback Statute. Most of the alterations take effect on Jan. 19, 2021.

The changes are intended to modernize law and provide flexibility to providers, though

Here’s a brief overview of the changes.

• New value-based exceptions permitting compensation arrangements designed to coordinate care and improve care quality while lowering costs.
• A new cybersecurity technology donation exception was created, while the existing exception for electronic health record systems donations was expanded.
• A new exception enables physicians to receive remuneration of up to $5,000 per year for items or services rendered by the doctor.
• A clarification of how a physicians group can distribute profits from Designated Health Services (DHS). “Split-pool” profit-sharing is no longer allowed. Note: this clarification takes effect on Jan. 1 of 2022.
• The Stark Law Final Rule contains new definitions of the terms “commercially reasonable” and “general market value” and revises “volume or value” and “fair market value.” The changes are intended to clarify and modernize the Stark Law while continuing to protect Medicare from fraud and abuse.