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Lesson Two:
Federal Anti-Kickback Statute and Stark Law
Honesty & Confidentiality Lesson Two: Federal Anti-Kickback Statute and Stark Law
Created by LCD 2 ©BAYADA Home Health Care, 2018
Do not modify or reproduce without written permission from the Learning Curriculum and Design Office. Rev. 7/2018
Introduction: Welcome to Honesty and Confidentiality Lesson Two:
Federal Anti-Kickback Statute and Stark Law.
In lesson one, we focused on key elements of the compliance program. In this lesson we’ll begin a discussion about the laws that govern our work.
Our Objectives: At the end of this lesson you will be able to:
Recognize the laws, regulations, standards, and policies that govern our work at BAYADA
Act in accordance with the Anti-Kickback Statute and Stark Law
We’ll begin with the Anti-Kickback Statute.
Honesty & Confidentiality Lesson Two: Federal Anti-Kickback Statute and Stark Law
Created by LCD 3 ©BAYADA Home Health Care, 2018
Do not modify or reproduce without written permission from the Learning Curriculum and Design Office. Rev. 7/2018
The Federal Anti-Kickback Statute:
The Federal Anti-Kickback Statute prohibits individuals or entities from knowingly and willfully offering, paying, soliciting, or receiving “remuneration” or kickbacks to generate referrals of items or services paid for by a federally funded program. In short, we may not directly or indirectly pay clients or other health care providers to refer clients to us.
Medicare and Medicaid are examples of federally funded programs covered by the Anti-Kickback Statute.
How does it Work?: The Anti-Kickback Statute is intended to prevent:
Medical judgment and treatment decisions being compromised because of an expectation of kickbacks
Increased costs to Medicare or Medicaid programs because unnecessary or excessive care has been provided
The overutilization of items or services covered by a federal health program
Unfair competition
The law is complex and has limited exceptions. Many states have similar laws. The Compliance office can help with questions about the Anti-Kickback Statute. When in doubt, do the right thing and ask for help.
Honesty & Confidentiality Lesson Two: Federal Anti-Kickback Statute and Stark Law
Created by LCD 4 ©BAYADA Home Health Care, 2018
Do not modify or reproduce without written permission from the Learning Curriculum and Design Office. Rev. 7/2018
What are Kickbacks?: Kickbacks are gifts, gratuities, incentives, or
anything of monetary value given to or from someone with the expectation or understanding that they will make referrals to us.
In addition to cash and cash equivalents such as gift certificates or gift cards, examples of prohibited kickbacks include:
Gifts and other financial incentives given with an expectation of future referrals or as a reward for past referrals
Supplies, equipment, space provided free or at less than fair market value, or space rented for more than fair market value
Free trips, lodging, and food in excess of what is allowed by BAYADA policies
Excessive discounts
How do I Avoid Violating the Law?: You may be thinking, how do I
avoid violating the law? In alignment with The BAYADA Way, our goal is always to do the right thing:
Exercise common sense with gifts, gratuities, incentives or anything of monetary value given to or from a referral source
If you have questions or concerns contact the Compliance office
Honesty & Confidentiality Lesson Two: Federal Anti-Kickback Statute and Stark Law
Created by LCD 5 ©BAYADA Home Health Care, 2018
Do not modify or reproduce without written permission from the Learning Curriculum and Design Office. Rev. 7/2018
Do the Right Thing 1: Let’s try a scenario. The local infusion company
routinely visits the office to drop off cookies, candy, and treats for the staff.
The infusion company marketer is particularly friendly with one clinical manager, and they have developed a good rapport.
Each time the marketer leaves she says, “Remember all these goodies next time you need an infusion company.”
Should the office staff accept the treats?
Yes – Incorrect. Accepting the gifts could give the impression that you intend to provide a referral in return, which would be in violation of the Anti-Kickback Statute.
No – Correct. Accepting the gifts could give the impression that you intend to provide a referral in return, which would be in violation of the Anti-Kickback Statute.
Do the Right Thing 2: The following week, the infusion company
marketer offers the clinical manager an expensive concert ticket to join the marketer as her guest for a sold-out concert.
Should the clinical manager go?
Yes – Incorrect. Accepting the tickets could give the impression that you intend to provide a referral in return, which would be in violation of the Anti-Kickback Statute.
No – Excellent. Accepting the concert tickets could give the impression that you intend to provide a referral in return, which would be in violation of the Anti-Kickback Statute
Honesty & Confidentiality Lesson Two: Federal Anti-Kickback Statute and Stark Law
Created by LCD 6 ©BAYADA Home Health Care, 2018
Do not modify or reproduce without written permission from the Learning Curriculum and Design Office. Rev. 7/2018
The Federal Stark Law: The Federal Self-Referral or Stark Law
prohibits a physician from referring Medicare or Medicaid clients to a health care provider if the physician, or an immediate family member of the physician, and the provider have any type of financial relationship. However, referrals are permitted if the financial relationship is structured to comply with certain exceptions to the Stark Law.
How Does it Work?: Unlike the Anti-Kickback Statute which requires
that parties knowingly violate the law, the Stark Law is a “strict liability” statute.
This means that even unintentional violations of the Stark Law may have significant consequences to the individuals involved and their organizations.
Honesty & Confidentiality Lesson Two: Federal Anti-Kickback Statute and Stark Law
Created by LCD 7 ©BAYADA Home Health Care, 2018
Do not modify or reproduce without written permission from the Learning Curriculum and Design Office. Rev. 7/2018
Exceptions: If the relationship does not comply with an exception, the
physician cannot refer clients to the provider with whom they have a financial relationship, and the provider cannot bill for services provided to those clients.
BAYADA employees with questions about whether a particular situation may involve the Stark Law should contact the Compliance office for guidance before proceeding.
Do the Right Thing 3: In this scenario, a physician provides medical
advisory services to BAYADA and is paid for these services.
Under the Stark Law, does this result in a financial relationship?
Yes – Correct. For purposes of the Stark Law, a financial relationship occurs whenever anything of economic value is transferred between BAYADA and a physician, or one of the physician’s immediate family members. Therefore, a written contract must exist and be structured to comply with an exception under the Stark Law. For additional information, please see policy 0-9135.
No – You have answered incorrectly. For purposes of the Stark Law, a financial relationship occurs whenever anything of economic value is transferred between BAYADA and a physician, or one of the physician’s immediate family members. Therefore, a written contract must exist and be structured to comply with an exception under the Stark Law.
Honesty & Confidentiality Lesson Two: Federal Anti-Kickback Statute and Stark Law
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Congratulations: Congratulations, you are ready to move on to lesson
three!
8 Created by LCD Do not modify or reproduce without written permission from the Learning Curriculum and Design office.
©BAYADA Home Health Care Rev. 7/2018