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Under the Federal Anti-Kickback Statute it is a felony to knowingly and willfully offer, pay, solicit, or receive payment, directly or indirectly, in order to gain business reimbursable by any federal health care program, cf. 42 U.S.C. § 1320a-7b(b).
With years of courtroom success and insider knowledge of federal kickback investigations, our anti-kickback defense lawyers fight to protect clients facing allegations relating to the Anti Kickback Statute and Stark Law.
Book a free, confidential consultation online or call (404) 496-4052 to discuss your kickback case.
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Call Us Today: (404) 496-4052
Investigation terminated; no prosecution. DOJ notified our client, the CEO of a major hospital network, that he was the target of a multi-million-dollar healthcare fraud investigation related to “Medicare upcoding” that the FBI and HHS-OIG […]
The FBI and the HHS-OIG investigated our client for Health Care Fraud based on the client’s submitting over $7 million in alleged false claims to Medicare. The Government indicted our client on Conspiracy to commit […]
HHS-OIG investigated our client for Healthcare Fraud and Aggravated Identity Theft based on the client’s allegedly participating in a “telemedicine” kickback scheme that defrauded Medicare of approximately $30 million in reimbursements for not-medically-necessary durable medical […]
A private insurance company discovered that our client, a dentist, fraudulently billed it, various other insurance companies, and federal health care benefit programs for approximately $400,000 of services that our client did not provide. We […]
The Department of Justice’s Criminal Division, Fraud Section charged our client and nine other individuals in a $1.4 Billion health care fraud, wire fraud, and money laundering conspiracy (the largest health care fraud case that […]
Investigation terminated; no prosecution. DOJ notified our client, the CEO of a major hospital network, that he was the target of a multi-million-dollar healthcare fraud investigation related to “Medicare upcoding” that the FBI and HHS-OIG […]
The FBI and the HHS-OIG investigated our client for Health Care Fraud based on the client’s submitting over $7 million in alleged false claims to Medicare. The Government indicted our client on Conspiracy to commit […]
HHS-OIG investigated our client for Healthcare Fraud and Aggravated Identity Theft based on the client’s allegedly participating in a “telemedicine” kickback scheme that defrauded Medicare of approximately $30 million in reimbursements for not-medically-necessary durable medical […]
A private insurance company discovered that our client, a dentist, fraudulently billed it, various other insurance companies, and federal health care benefit programs for approximately $400,000 of services that our client did not provide. We […]
The Department of Justice’s Criminal Division, Fraud Section charged our client and nine other individuals in a $1.4 Billion health care fraud, wire fraud, and money laundering conspiracy (the largest health care fraud case that […]
The Anti-Kickback Statute (AKS) prohibits offering, paying, soliciting, or receiving anything of value in exchange for referrals involving items or services covered by federal healthcare programs like Medicare or Medicaid.
A violation of this federal law can result in:
The government must demonstrate that a payment was made between the parties and that it was made with improper intent. It is not necessary to show that the individuals specifically intended to break the law governing federal healthcare programs.
Under the Anti-Kickback Statute, the term “remuneration” is broadly interpreted to mean anything of value, including discounts.
The statute specifically identifies kickbacks, bribes, and rebates as forms of remuneration, regardless of whether they are provided directly or indirectly, and whether they involve cash or non-cash benefits. This definition extends to goods and services. See 42 U.S.C. § 1320a-7b(b).
Another section of the law, 42 U.S.C. § 1320a-7a(i)(6), further expands the definition to include waived copayments and discounts on healthcare items or services. However, the statute carves out certain exceptions, or “safe harbors,” that protect specific practices such as waivers or discounts offered based on financial need or when compliant with specific regulatory conditions.
Regulations issued by the Office of Inspector General at the Department of Health and Human Services underscore how broadly “remuneration” is defined under this law.
Intent can be inferred from context, such as timing of payments, communication between parties, or patterns of referrals. Even indirect or circumstantial evidence can be used to demonstrate intent to induce referrals.
From the perspective of physicians and other healthcare providers, anti-kickback allegations often arise in the midst of broader investigations into healthcare fraud or billing irregularities. Federal agencies like the Department of Justice (DOJ), the Office of Inspector General for Health and Human Services (HHS-OIG), and the FBI actively pursue these cases, often scrutinizing common industry practices that providers may view as legitimate.
Medical professionals may find themselves under investigation for:
Participating in marketing or consulting arrangements that include compensation tied to patient referrals.
Referring patients to businesses such as imaging centers, home health services, or pharmacies with which they have a financial relationship.
Accepting speaking engagements, free samples, or honoraria that authorities later claim were meant to influence referrals.
The Anti-Kickback Statute includes Safe Harbors that protect certain legitimate business arrangements from prosecution. These include:
Our lawyers analyze and structure your contracts to ensure they align with safe harbor rules and minimize your exposure to potential criminal penalties.
The government must demonstrate that a payment was made between the parties and that it was made with improper intent. It is not necessary to show that the individuals specifically intended to break the law governing federal healthcare programs.
Lowther | Walker provides immediate, strategic analysis when a provider is under investigation. By reviewing contracts, referral patterns, and financial arrangements, the firm can identify exposure points and guide clients on how to respond to subpoenas, audit requests, or federal inquiries without incriminating themselves or worsening the situation.
Our team helps healthcare organizations implement or revise internal compliance programs to withstand regulatory pressure. This includes conducting internal audits, training staff, reviewing referral relationships, and creating defensible documentation protocols. This is critical for providers recovering from or trying to prevent enforcement actions.
Clients facing exclusion from Medicare or Medicaid due to an anti-kickback case can rely on Lowther | Walker to challenge or negotiate those decisions. The firm understands the immense impact exclusion can have on a provider’s career and takes swift action to contest or resolve the matter.
When the stakes are high, you need lawyers who understand how the government builds these cases and how to dismantle them. Whether you’re under investigation or charged under the Anti-Kickback Statute, our defense team is ready to fight for you and your career. Request a free consultation by calling (404) 496-4052 or contact us online. Our team will respond within minutes of your call.
No-obligation. Fully confidential.
Call Us Today: (404) 496-4052
Your lawyer should have proven experience winning anti kickback cases. They should have knowledge, for example, of the latest safe harbor rules issued January 19, 2021, regarding “value-based enterprises”.
While both laws regulate healthcare referrals, the AKS applies to any form of remuneration for referrals, whereas the Stark Law only applies to physician referrals for certain services when there is a financial relationship with the entity receiving the referral.
Intent can be inferred from context, such as timing of payments, communication between parties, or patterns of referrals. Even indirect or circumstantial evidence can be used to demonstrate intent to induce referrals.
Yes. If an EHR vendor provides discounts, training, or services that benefit a provider financially and are tied to referrals or usage of a reimbursable product, this may trigger AKS scrutiny.
