A recent settlement involving a Medicare Advantage plan should serve as a reminder that the federal Anti-Kickback Statute (AKS) is broad and far-reaching, both on its face and in practice.
On July 1, 2022, the U.S. Department of Justice (DOJ) and U.S. Department of Health and Human Services Office of Inspector General (OIG) announced that a Medicare Advantage plan (Plan) agreed to pay $4.2 million to resolve False Claims Act allegations that the Plan violated the AKS by offering kickbacks to healthcare professionals (Settlement).1
Specifically, according to the Settlement announcement, the Plan allegedly distributed gift cards over the course of a little more than a year to administrative assistants of providers to induce the assistants to refer, recommend or arrange for enrollment of Medicare beneficiaries into the Plan. As such, the government contends that the Plan submitted or caused to be submitted claims to the Medicare Program tainted by this AKS violation.
The Settlement highlights the breadth of the AKS, as well as the flexibility that enforcement authorities have in utilizing the AKS as a vehicle to deter behavior deemed to be problematic. The AKS, in relevant parts, prohibits the knowing and willful offer or payment of any remuneration, either directly or indirectly, in return for referring, recommending or arranging for an item or service that is reimbursable, in whole or in part, under a federal healthcare program.
More common allegations involving violations...
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