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What should you know about kickbacks in healthcare?

On Behalf of | Jul 28, 2023 | Whistleblowing |

Patients trust doctors. They trust that doctors have their best interest at heart, and that they are relying on their expert medical judgement to help them find treatment options, including the necessary and appropriate pharmaceuticals, durable medical equipment, and other goods and services that best fit their needs and their situation.

Unfortunately, not every healthcare provider makes decisions based on what is best for the patient. Some healthcare providers are influenced to make choices for patients based on what will benefit their own financial interests. One form this influence can take is known as a “kickback.” Receiving and keeping Medicare, Medicaid, and other insurance payments for healthcare services that are prescribed or rendered by a healthcare provider who has received kickbacks can constitute healthcare fraud under the False Claims Act.

Similarly, some doctors offer illegal kickbacks to patients. For example, if a patient has Medicare, Medicaid or other Government-funded health insurance, then free or discounted services; coupons or gifts; and copay waivers can all constitute unlawful forms of compensation that healthcare providers may offer to patients, in order to convince them to agree to purchase Medicare-covered services and products.

What are kickbacks?

Kickbacks occur when a healthcare provider receives compensation – including benefits other than cash payments – for using, ordering, prescribing, or buying a specific drug, medical device, service or other Medicare or Medicaid-covered healthcare service or product. These kickbacks are unlawful inducements regardless of whether they are provided before the healthcare provider makes their decision or as a reward after the fact.

Some of the forms that kickbacks can take in the healthcare industry are:

  • Money – Paying for referrals or offering money for using a specific product or service is one of the most direct forms of kickback.
  • Gifts or other free goods – Free goods or services, pay for travel or meals, provide entertainment or other benefits can be forms of non-monetary compensation.
  • Discounts – Sometimes, kickbacks come in the form of discounts. This can include discounted pricing for goods or services, rebates provided after a purchase or deviating from the fair market value for the product or service.

When people or companies use kickbacks to influence a physician or health care provider, or patients,  those kickbacks are not simply unethical. Kickbacks also violate federal statutes and can lead to increased costs and unfair competition.

What can you do if you are aware of kickbacks?

Patients do not only rely on doctors and nurses to protect their health and wellbeing. They also rely on people willing to report kickbacks and other fraudulent behavior that occurs in healthcare facilities. Blowing the whistle on these illegal actions can hold healthcare providers responsible.

If you know about violations of the federal Anti-Kickback Statute, you may want to seek legal guidance to help you understand the potential rewards for whistleblowing and take steps to protect your rights. With the right support, you can push back against kickbacks while also protecting your career.

An experienced whistleblower can explain the complex laws and procedures applicable to kickback violations and also explain what kind of evidence is needed and how to go about gathering such evidence without getting in trouble.