Question: If there are kickbacks for referrals between my doctors
From: Christian F. of Pittsford, New York
Answer: There has been a federal anti-kickback law in effect since 1972. The purpose is to protect patients and the federal government from fraud and abuse by limiting the financial influence on healthcare decisions and from abusive referral patterns. The law states that anyone who knowingly and willfully receives or pays anything of value to influence the referral of federal health care program business, including Medicare and Medicaid, can be held accountable for a felony. Punishment may include fine and/or imprisonment. Healthcare providers the law too broad. In 1987, Congress authorized the designation of “safe harbors” to protect certain payment and business practices from prosecution. One is the Specialty Referral Arrangements Between Providers that protects certain arrangements between physicians. For example, a primary care physician refers a patient to a specialist with the understanding that the patient will be referred back to the PCP when the patient reaches a certain point. Safe harbor, however, does not protect splitting a global fee from a federal program. Sharing a fee with another physician or healthcare provider for getting the referral is considered renumeration for referrals and may be subject to disciplinary action.
Ruthann Russo, PhD, JD, MPH, RHIT, is a healthcare expert with more than 20 years of experience working in and advising healthcare organizations.
