Medical professionals in Texas, like all physicians nationwide, must comply with the Anti-kickback statute. This law prohibits any practicing medical professional from receiving or giving payment for patient referrals in federally funded programs like Medicare and Medicaid.

Most often, referral arrangements occur between sole-proprietor physician offices and ancillary support services such as home health care. This type of arrangement often faces scrutiny for health care fraud.  In a recent example, one Texas physician charged more than $16 million in false and fraudulent claims to Medicare in part by collecting a patient fee for certifying individuals to receive home health services.

Penalties

The penalties for violating the Anti-kickback law can completely derail a medical career. In Texas, the consequences can be even harsher due to the Solicitation of Patients Act signed into law in 1999. While, depending on the situation, either civil or criminal court can deal with the Anti-Kickback Statute, the Solicitation of Patients Act pushes charges into criminal court.

Violating the Anti-kickback statute can result in:

  • A prison sentence
  • Fines up to 25,000 per violation
  • Inability to provide Medicare or Medicaid services
  • Loss of medical license

Exceptions

Even if the patient did medically require the services, the Anti-kickback penalties may apply. But not all referral situations fall under the Anti-kickback statue’s jurisdiction. For a conviction, the government must prove that the physician acted with intent – that is, knowingly and willfully accepted or offered payment for referrals to federally funded treatment programs.

Federal law also recognizes some exceptions to the Anti-kickback statute. These exceptions, known as regulatory Safe Harbors, include paying a recruitment fee to attract a medical professional to an underserved or rural area or the sale of a retiring physician’s practice to a new physician.

Due to the complicated nature of the Anti-Kickback statute and the Safe Harbor exceptions, medical professionals should consider legal counsel for each specific situation.