Referral Rep Opportunity for Healthcare Professionals
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Legal Issue for Some Professionals
Most healthcare providers know or should know of the federal laws governing the issues of remuneration for referring patients to treatments and other medical services. The two primary laws are known as the Stark Law (42 U.S.C. §1395nn) and the Anti-Kickback Statute (42 U.S.C. § 1320a-7b). Below is a brief review by way of reminder.
Federal Stark Law
Stark Law is a set of United States federal laws that prohibit physician self-referral specifically a referral by a physician of a Medicare or Medicaid patient to an entity for the provision of designated health services ("DHS") if the physician (or an immediate family member) has a financial relationship with that entity.
The term "referral" means "the request by a physician for the item or service" for Medicare Part B services and "the request or establishment of a plan of care by a physician which includes the provision of the designated health service" for all other services. DHS includes "clinical laboratory services"; "physical therapy services"; "occupational therapy services"; "radiology services, including magnetic resonance imaging, computerized axial tomography scans, and ultrasound services"; "radiation therapy services and supplies"; "durable medical equipment and supplies"; "parenteral and enteral nutrients, equipment, and supplies"; "prosthetics, orthotics, and prosthetic devices and supplies"; "home health services"; "outpatient prescription drugs"; "inpatient and outpatient hospital services"; and "outpatient speech-language pathology services." A "financial relationship" includes ownership, investment interest, and compensation arrangements.
The Anti-Kickback Statute (AKS) is an American federal law prohibiting financial payments or incentives for referring patients or generating federal healthcare business. The law imposes criminal and, particularly in association with the federal False Claims Act, civil liability on those who knowingly and willfully offer, solicit, receive, or pay any form of remuneration in exchange for the referral of services or products covered by any federal healthcare program (e.g., the referral of a Medicare patient for an MRI), subject to certain narrow exceptions. In other words, the statute covers both those who provide (or offer) kickbacks and those who receive (or solicit) kickbacks. Violation of the AKS is a felony.
The AKS was "enacted to ensure that clinical decisions and medical services are provided to patients based on their medical needs and not on the improper financial considerations of providers". The illegal remuneration covered by the AKS includes "anything of value" and is therefore not limited to cash. Thus, the sorts remuneration barred by the AKS may be, for example, in the form of consulting fees, gifts (e.g., sports tickets), discounted rent, research grants, and bonuses. The AKS is a separate law from the Stark Law; however, the AKS may, in many instances, cover conduct within the scope of the Stark Law (and vice versa).
Federal Anti-Kickback Statute
All but one of the 50 states, as well as the District of Columbia, have analogous laws on the books that target corruption in the health care industry. And of these 51 jurisdictions, 35 proscribe kickbacks and the like in the health care industry even if the goods or services are reimbursable only by private health insurance and involve no public money at all. These additional state laws and regulations thus often reach far beyond their federal counterpart.
State Level Laws
First, we take the position that the laws reach beyond just practitioners. Any person that owns or otherwise has a financial stake in a medical practice or organization should apply these laws to him or herself as well. That said, how can such persons or physicians participate as a rep in our program?
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Simply put, you may only receive commissions from referring our solutions to other practices and healthcare organizations with whom you have NO financial interest or patients.