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Spotting "Sham" kickback schemes and avoiding the tabloids

          May 21,2015
 
Everyday practice is ripe with third parties (labs, other practitioners, vendors, etc) seeking to induce referrals from you, and offering deals to make that happen.  Sometimes the inducements offered are packaged in a seemingly appropriate arrangement - possibly the offering of "free services" or a consulting arrangement, whereby monies will be paid to your practice in exchange for access to patients or referrals. As with Tuesday's email referencing audit activity, the Office of the Inspector General similarly reviews potentially inappropriate arrangements. 

recent press release brings attention towards potential kickback exposure couched in a "sham" services agreement.  Without much additional information included, OIG reports a physician's arrest and imprisonment for a period of 14 months and a fine of $75k, plus the physician is ordered to forfeit more than $630k in outstanding reimbursement. In this instance, the physician admitted he accepted bribes in return for sending patient blood specimens to the paying lab in amounts in excess of $100,000, often more than $5,000 per month through "sham lease and sham service agreements".  In addition to acknowledging receipt of the bribes, the physician in this instance failed to report the bribes as income, as well as failed to disclose $540k in patient co-pays - amounting to more than $160k in unpaid taxes.

Clearly this recently available case study documents egregious conduct, however it also serves as a cautionary tale because the spectrum of potential non-compliance is a slippery slope. 

If you are approached with a prospective arrangement be sure to review with your healthcare attorney before signing on. For more information on OIG enforcement actions or to see whether any of your colleagues land on their hot list, click here: https://oig.hhs.gov/fraud/enforcement/criminal/index.asp

 


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