DHHS Office of Inspector General Signals Willingness to Sanction Individual Physicians Under the Anti-Kickback Statute

By Matthew J. Effken.  The U.S. Department of Health and Human Services Office of Inspector General (OIG) has released a new fraud alert that shows a willingness to impose financial sanctions directly on individual physicians under the Anti-Kickback Statute, and also encourages whistle-blowers to report physicians who participate in questionable compensation arrangements.

The fraud alert highlights the potential risks to physicians of entering into questionable medical directorships and staffing arrangements. The alert notes that the OIG has recently reached settlements with 12 individual physicians in cases involving compensation for medical directorships where the services either were not actually rendered or were compensated at greater than fair market value.

Some settlements also involved cases where physicians’ office staff salaries were paid for by affiliated health care entities, thereby relieving the physicians of a financial burden they otherwise would have incurred. In all cases, the payments were alleged to be remuneration to the physicians based on the volume or value of referrals.

The OIG appears to be signaling that they will not hesitate to impose financial penalties on individual physicians, not just larger corporate entities, when the agency finds a violation of the Anti-Kickback statute. The fraud alert also serves as a reminder that parties on both sides of a problematic transaction are subject to civil and criminal liability when the Anti-Kickback statute is violated.

In addition, the fraud alert reaffirms the rule that a compensation arrangement may violate the Anti-Kickback statute if just “one purpose” of the arrangement –not the only purpose or the main purpose–is to provide compensation for past or future referrals of Federal healthcare program business.

Finally, the fraud alert encourages potential whistle-blowers to report physicians who may be violating the Anti-Kickback Statute and includes both a web-link and toll-free hotline number to make such reporting easier.

The OIG Fraud Alert on physician compensation is available at the following link:

http://oig.hhs.gov/compliance/alerts/guidance/Fraud_Alert_Physician_Compensation_06092015.pdf

© 2015 Houghton Vandenack Williams

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