Physician “kickbacks” are money, services, gifts, or other exchanges that a physician accepts in return for referring a patient to a doctor, medication, or service. Kickbacks regarding patients who receive some support from federal funding, such as Medicare or Medicaid, are forbidden by federal law and for good reason. You can imagine, for example, a physician who receives money from a pharmaceutical company for prescribing a new drug to a patient. A physician may be more influenced by his desire to receive the “kickback” than he is by the best health outcome for his patient. This is a classic conflict of interest and it is clear to see why kickbacks can be dangerous for patients.
Physician kickbacks, however, are notoriously difficult to uncover. Because they are widely known to be in violation of federal law, kickbacks may take more subtle forms. Instead of a pharmaceutical company cutting a big check to physicians who prescribe their medication, for example, maybe a pharmaceutical representative lets a physician borrow a ski cabin for a weekend free of charge. Perhaps instead of paying physicians for prescribing medication, a specialty practice or pharmaceutical company may reward a physician referring its medications or services with a highly paid consultant position. It may even be as simple as as innocuous sounding as a doctor receiving weekly lunches catered to his or her office in exchange for using a certain medical device.
Often, the only people who are able to observe kickbacks are the physician’s employees or pharmaceutical representatives encouraged to engage in the inappropriate behavior. This is where whistleblowers come in. If you have observed physicians taking kickbacks, you should strongly considering consulting with an experienced whistleblower attorney who can help you determine whether your claims should be reported and the best route for reporting it. In the meantime, here are a few frequently asked questions about kickback reporting:
- What federal law prohibits kickbacks? The Anti-Kickback Statute (AKS), a federal law making it a crime to offer or receive kickbacks regarding Medicare or Medicaid patients, or patients who otherwise receive some federal funding for their care.
- How do I report kickbacks? You can report kickbacks violating AKS by contacting your local department of health and human services. You should also strongly consider filing a Qui Tam lawsuit under the False Claims Act (FCA). With the help of an experienced healthcare whistleblowing attorney you may be able to file a lawsuit on behalf of yourself and the government regarding the fraud. This may entitle you to recover a percent of the monetary reward resulting from the lawsuit, if it is successful.
- Does the AKS or FCA offer whistleblower protection? Yes. Both the AKS and FCA offer protection for whistleblowers by forbidding employers for terminating your employment or retaliating against you for blowing the whistle. If you are terminated or retaliated against, your remedy will likely be to sue your employer under these statutes to recover money damages.
Remember, an experienced whistleblower attorney, like a whistleblower lawyer in Richlands, Virginia, specializing in healthcare fraud reporting can help you understand the answers to these questions in more detail. They can also analyze the facts of your specific case to make a specific recommendation that is right for you.
Thank you to the experts at the Law Offices of Mark T. Hurt for their insight into whistleblower law.