By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
The federal Anti-Kickback Statute prohibits remuneration in relation to the provision of a “good, facility, service, or item for which payment may be made in whole or in part under a Federal health care program.” 42 U.S.C. § 1320a-7b(b). The Anti-Kickback Statute goes on to define “federal health care program” as any government funded plan or program that provides health benefits or any state health care program. 42 U.S.C. § 1320a-7b(f). But exactly which payers are considered Federal health care programs? There is a lot of confusion on this issue. Hopefully this will clarify it.
The List of Federal Payers for To Which the Anti-Kickback Statute Applies.
The list of federal and state programs to which the Anti-Kickback Statute applies is a long one. The state ones are on there primarily because they receive some level of federal funding. This list includes many programs, some of which you may have never heard or guessed. Here are the ones of which I am aware:
The Medicare Program (along with managed care plans that may contract with the Medicare Program, a number of private insurers);
The Medicaid Program (along with managed care plans that may contract with the various state Medicaid Programs-the private insurers which do this);
State Children’s Health Insurance Program (CHIP or SCHIP);
TRICARE and Tricare for Life;
CHAMPVA;
Veterans Administration (VA) Services;
Indian Health Services (IHS);
Federal Health Program for Alaska Natives;
Railroad Employees National Health and Welfare Plan (RENHWP);
Federal Employees’ Compensation Act (FECA) program;
The Longshore and Harbor Workers’ Compensation Act (LHWCA);
The Federal Black Lung Benefits Act program (FBLBA);
The Energy Employees Occupational Illness Compensation Program Act (EEOIC) (also known as the “Beryllium Exposure Compensation Act”) program;
Refugee Medical Assistance (RMA) program;
Federal Reimbursement of Emergency Health Services to Undocumented Aliens program; and
The Ryan White HIV/AIDS Program.
These programs cover a very wide swath of all health services offered in the United States. Therefore, nearly every medical item, facility, service, or equipment is potentially payable by a federal health care program.
Note, however, the Federal Employee Health Benefit (FEHB) Program, the program that provides insurance and benefits to federal civilian employees, is not included in the above list of payers, by statutory exemption. 42 U.S.C. § 1320a-7b(f); 5 U.S.C. Ch. 89.
The Public Health Service (PHS) and its programs may also be excluded from application. See 42 U.S.C. § 1320a-7b(b)(3)(D).
Cross-over with the False Claims Act.
Compliance with the Anti-Kickback Statute is a Condition of Payment for the federal health care programs. Every claim that is submitted for payment contains an attestation that the provider providing the goods or services for which payment is sought has complied with the federal Conditions of Payment.” Therefore, if there has been a kickback in relation to such goods or services for which a claim is made, the False Claims Act will also apply.
Contact Health Law Attorneys Experienced with Health Care Fraud, False Claims Act Violations, and Anti-Kickback Statute Violations.
The attorneys of The Health Law Firm represent healthcare providers in cases of medical billing fraud, overbilling, Medicare audits, Integrity Contractor audits and RAC audits, False Claims Act cases, and whistleblower/qui tam cases throughout Florida and across the United States. Our attorneys also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in the practice of health law. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.
KeyWords: Healthcare fraud legal defense representation, healthcare fraud defense lawyer, healthcare fraud defense attorney, Stark Law defense lawyer, Stark Law defense representation, Anti-Kickback Statute (AKS) defense legal representation, AKS defense attorney, AKS lawyer, AKS representation, Centers for Medicare & Medicaid Services (CMS) defense attorney, CMS legal defense representation, CMS defense attorney, CMS legal defense lawyer, legal representation for CMS investigation, whistle blower plaintiff-relator attorney, qui tam suit plaintiff-relator attorney, False Claims Act (FCA) suit plaintiff-relator attorney, Medicare audit defense attorney, Medicare audit defense legal representation, Medicare audit defense lawyer, Medicaid audit defense attorney, Medicaid audit defense legal representation, Medicaid audit defense lawyer, Medicaid Fraud Control Unit (MFCU) defense attorney, Medicaid Fraud Control Unit (MFCU) defense legal representation, Medicaid Fraud Control Unit (MFCU) defense lawyer, Medicare overpayment demand defense attorney, Medicare overpayment demand defense legal representation, Medicare overpayment demand defense lawyer, Office of Inspector General (OIG) investigation defense attorney, Office of Inspector General (OIG) investigation defense legal representation, Office of Inspector General (OIG) investigation defense lawyer, Civil Monetary Penalty defense attorney, Civil Monetary Penalty defense legal representation, Civil Monetary Penalty defense lawyer, Whistle blower suit defense attorney, Whistle blower suit defense legal representation, Whistle blower suit defense lawyer, Qui tam suit defense attorney, Qui Tam suit defense legal representation, reviews of The Health Law Firm, The Health Law Firm attorney reviews, qui tam suit defense lawyer, False Claims Act suit defense attorney, False Claims Act suit defense legal representation, False Claims Act suit defense lawyer, representation for allegations of overbilling, representation for FCA investigations, Office of Inspector General (OIG) interview defense attorney, Office of Inspector General (OIG) interview defense legal representation, Office of Inspector General (OIG) interview defense lawyer
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 The Health Law Firm. All rights reserved.