New York City Qui Tam Attorneys for Illegal Kickbacks

Each year, whistleblowers in cases involving kickbacks, improper referrals, and other forms of healthcare fraud receive hundreds of millions of dollars in compensation from the federal government. Without an effective watchdog system in place, the government relies on private citizens to uncover and report these instances of illegal activity.

If you have information about an illegal kickback, it is important to take action. At Schwartzapfel Lawyers P.C., we help whistleblowers throughout New York sue on behalf of the government and stake their claims to just compensation.

Illegal Kickbacks in the Healthcare Industry

The Federal Anti-Kickback Statute

The Anti-Kickback Statute is a federal law that prohibits exchanging or offering to exchange anything of value in order to influence a decision about a patient’s healthcare (referred to as a “kickback”). The law is not all-encompassing – there are certain transactions that are permitted and there are “safe harbors” that apply to specific circumstances – but when it applies, the Anti-Kickback Statute governs the activities of the parties on both sides of the transaction. As a result, whistleblowers can file claims against parties that both provide and receive illegal kickbacks.

Common Illegal Kickback Schemes

Illegal kickbacks in the healthcare industry take many forms. In addition, as the government increases its enforcement efforts under the False Claims Act, violators are finding new and novel ways to structure kickbacks and attempt to hide their activities from the government. However, in broad terms, some of the most common forms of illegal kickbacks include:

  • Kickbacks from pharmaceutical companies – Pharmaceutical companies may offer payments or discounts to physicians in exchange for recommending their medications to patients and colleagues.
  • Kickbacks from medical device manufacturers – Manufacturers of medical devices (implants, surgical tools, and medical equipment) often offer improper incentives to hospitals and physicians as well.
  • Swapping arrangements with medical service providers – Hospitals may enter into arrangements with ambulance companies, medical labs, and other service providers to receive discounts in exchange for referrals.
  • Patient kickbacks – In some cases, patients have even received kickbacks in exchange for undergoing medical treatments that their physicians could bill to the government.

Improper Physician Referrals

In addition to the Anti-Kickback Statute, there is another important law that applies specifically to financial arrangements involving doctors and their family members. With only limited exceptions, the Stark Act makes it illegal for a physician to refer business to a “designated health service” with which the physician or one of his or her family members has a financial relationship. Designated health services under the Stark Act include:

  • Clinical laboratory services
  • Home health services
  • Inpatient and outpatient hospital services
  • Medical equipment and supplies
  • Occupational therapy services
  • Outpatient prescription drugs
  • Outpatient speech-language pathology services
  • Parenteral and enteral nutrients, equipment, and supplies
  • Physical therapy services
  • Prosthetics, orthotics, and prosthetic devices and supplies
  • Radiation therapy services and supplies
  • Radiology and certain other imaging services

For purposes of the Stark Act, a “financial relationship” includes owning, investing in, or receiving compensation from a designated health service provider. As a result, Stark Act violations are often also referred to as physician self-referrals.

How Kickbacks Violate the False Claims Act

In order to participate in federally-funded healthcare programs, including Medicare and Medicaid, hospitals, private medical practices, and other healthcare providers are required comply with the Anti-Kickback Statute and the Stark Act. If a healthcare provider submits a payment claim to the government “that includes items or services resulting from a violation” of the Anti-Kickback Statute or that involves a violation the Stark Act, this is an express violation of the False Claims Act.

What to Do if You Have Information about an Illegal Healthcare Kickback

If you have information about an illegal kickback or improper physician referral, you may be entitled to compensation under the False Claims Act. The False Claims Act is a federal statute that the government uses to prosecute healthcare providers that engage in fraudulent billing activities – including illegal kickbacks.

As a private citizen, if you have information about a fraudulent claim, you are entitled to file a lawsuit under the False Claims Act on behalf of the government. If your claim is successful, you can receive up to 30 percent of the amount recovered.

In order to file a claim under the False Claims Act, you should:

  • Collect any evidence you have of the kickback or referral
  • Avoid discussing the situation with anyone involved in the improper activity
  • Speak with an experienced False Claims Act attorney as soon as possible

Schedule a Free, Confidential Consultation at Schwartzapfel Lawyers P.C.

At Schwartzapfel Lawyers P.C., we vigorously pursue cases under the False Claims Act on behalf of the brave whistleblowers who bring them to light. To speak with an attorney in confidence, contact us at 1-888-575-6410 or request a free consultation online today.