What Are the Penalties for Kickbacks in Health Care? Our National Criminal Law Attorneys Explain

Penalties for a violation of the Anti-Kickback Statute (AKS) are severe and costly. 

The penalties are assessed not only for the medical provider who pays kickbacks in health care, but also on the medical provider who receives those kickbacks — and they are assessed for each kickback.

According to Office of Inspector General (OIG), violations can carry criminal and administrative sanctions. These include fines, jail terms, and exclusion from Medicare, Medicaid and other federal health programs. 

Each violation can carry a fine of up to $50,000, in addition to three times the amount of the kickback.

In addition to monetary sanctions, violators may also be sentenced for up to five years in jail.

Further, a violation of the AKS also can serve as a basis for a False Claim Act violation. This is a great expansion of the False Claim Act, and it has served to strengthen the federal government’s enforcement of Medicare and Medicaid Fraud prevention laws.

In addition to the (AKS), federal law also prohibits medical providers from offering financial inducement directly to Medicare and Medicaid beneficiaries.

According to the Office of Inspector General’s publication “A Roadmap for New Physicians,” a medical provider may not systematically waive a Medicare or Medicaid beneficiary’s co-pay in order to encourage the patient to utilize the provider’s office or facility. It is possible to make concessions for individual patients that can show financial hardship, but this investigation must be documented for the individual.