Health care fraud, including illegal kickbacks to doctors and other health care providers, compromises patient care and costs, American taxpayers, billions of dollars every year. That’s why the law provides incentives to individuals who expose such wrongdoing, including a share of any amounts recovered from the perpetrators of such schemes. At Halunen Law, our anti-kickback lawyers recognize the courage it takes to blow the whistle on kickbacks and other acts of financial misconduct in the health care industry.
Sometimes just knowing where to start is a challenge. Then there is the fear of putting livelihoods and reputations at risk by taking those first steps. That’s why we are committed to working with whistleblowers and the government to stop healthcare fraud in its tracks by filing claims under the False Claims Act (FCA).
Our team is uniquely positioned to protect whistleblowers from prohibited retaliation. Unlike many FCA law firms, our firm has extensive employment law experience, and we regularly advise employees on how to protect themselves. If and when retaliation occurs, we can assist employees in bringing those claims along with an FCA lawsuit. Halunen Law’s anti-kickback lawyers work tirelessly to get our clients the compensation they deserve for their honesty and integrity.
What Are Illegal Kickbacks?
Kickback schemes have the purpose of inducing or rewarding referrals of healthcare program business. They can take many forms but generally involve dubious financial payments or anything of value provided to health care providers in exchange for referring patients to particular hospitals, labs, or other providers, or for prescribing or using specific drugs, devices, or durable medical equipment. Kickbacks also occur when a provider offers a “reward” to patients who switch to their goods or services.
Kickbacks are illegal when they involve services and products paid for by federal and state governments through health care programs such as Medicare, Medicaid, TRICARE, and CHAMPVA. Knowing that these payments are against the law, participants often try to obscure or hide them. Rarely will a kickback involve simply cutting a check or handing over an envelope of cash. More often, the illicit compensation takes other forms, such as:
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- Golf outings
- Payments for “consulting fees,” “research grants,” “speaking fees,” and other phony services
- Gifts
- “Bonus” payments
- Free or reduced rent
- Tickets to sporting events or concerts
- Vacations and travel junkets
- Expensive dinners
Given the sprawling nature of the American health care industry, prohibited kickback schemes can involve many individuals and organizations beyond physicians and hospitals, including:
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- Hospitals
- Nurses and staff
- Nursing homes
- Home health agencies
- Physical therapy clinics
- Ambulance companies
- Medical/diagnostic laboratories
- Hospices
- Hospital staffing companies
- Medical device companies
- Pharmaceutical companies
- Pharmaceutical marketing companies
- Pharmacies
The Problem With Kickbacks
Americans spend almost $4 trillion on health care every year, including billions spent by the federal and state governments on government-pay health care programs. Nearly 785,000 companies operate in the health care sector, employing millions of individuals, from physicians and nurses to administrators, lab technicians, office and janitorial staff, and countless others. With so much money and so many people involved, the opportunities for health care fraud and malfeasance, including illegal kickbacks, are abundant.
But kickbacks are against the law, and for good reason. These payments not only cloud medical judgment and decision-making but also raise health care costs for all Americans and divert money from patient care to the pockets of the corrupt participants in these schemes.
The False Claims Act Rewards Those Who Expose Kickback Schemes
Recognizing the human and financial costs of kickbacks in the health care industry, federal and state governments aggressively pursue individuals involved in such illegal enterprises. They do so using powerful laws designed to curb kickbacks, hold wrongdoers accountable, and reward those who help expose their fraud.
The primary federal healthcare anti-kickback laws are the Anti-Kickback Statute (AKS) and Stark Law, also called the “physician self-referral law.” Whistleblowers can report violations of these statutes through the FCA.
As its name suggests, the Anti-Kickback Statute prohibits bribes, kickbacks, or other “remuneration” to induce or reward the prescription of drugs or medical devices, patient referrals, or other business generation. It is a criminal statute enforced by the government.
The Stark Law prohibits offering, soliciting, paying, or receiving financial incentives to physicians to induce referrals for treatments, services, or products involving Medicare and Medicaid when the physician has a financial interest in those referrals. It is a civil statute enforced by the government.
The FCA allows individuals to bring claims alleging violations of the AKS and Stark Law on behalf of the government. In fact, the AKS explicitly states that violations of its provisions also constitute “false and fraudulent” claims under the FCA.
Under the “qui tam” provisions of the FCA, whistleblowers who expose this type of fraud against the government can receive a percentage share of any amounts recovered. For example, if the government collects $50 million in proceeds from a kickback claim brought by an individual under the FCA, that individual may receive a reward that typically ranges from 15 percent to 30 percent ($7.5 million to $15 million) of that $50 million.
Kickbacks are also illegal in connection with government contracting.
First Step: Contact Halunen Law Anti-Kickback Lawyers
If you know about an illegal kickback scheme or any other form of fraud against the government, the whistleblower attorneys at Halunen Law stand ready to support you as you consider whether and how to report the misconduct. We’ve recovered millions of dollars in rewards for whistleblowers who had the courage to do the right thing and millions of dollars in compensation for individuals who experienced retaliation. During a free, confidential consultation, our anti-kickback lawyers can answer your questions and help you determine if you have grounds to pursue a claim. Contact our firm at 612-605-4098 or submit this Contact Form online.
False Claims Act: 31 U.S.C. §§ 3729 et seq.
Anti-Kickback Statute: 42 U.S.C. § 1320a-7b (healthcare)
Stark Law: 42 U.S.C. § 1395nn
Anti-Kickback Act: 41 U.S.C. § 8702 (government contracting)