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October 11, 2017 Healthcare Fraud

The Anti-Kickback Statute vs. The Stark Law

There is much confusion between the Federal Anti-Kickback Statute and the Stark Law because both laws deal with remuneration related to improper referrals. But there are fundamental distinctions between the two laws. Anti-Kickback Statute [42 U.S §1320a-7b(b)] The federal Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b), (“AKS”) arose out of congressional […]
October 9, 2017 Healthcare Fraud

What is the Stark Law?

Section 1877 of the Social Security Act (“the Act”) (42 U.S.C. 1395nn) is also known as the physician self-referral law and is commonly referred to as the “Stark Law.”[1] The Stark Law was enacted in 1989 with the simple purpose of curbing physician self-referral. It was originally titled the Ethics […]
July 7, 2017 Healthcare Fraud

Bringing a False Claims Act Case Without Identifying Specific Claims to the Government

We wrote earlier about the important holding in one of this Firm’s cases, U.S. ex rel. Groat v. Boston Heart Diagnostics Corp., 2017 WL 2533341 (D.D.C. June 9, 2017), regarding the responsibility of a medical laboratory to ascertain whether lab tests ordered by physicians are medically necessary. That opinion also […]
June 23, 2017 Healthcare Fraud

When Does a Drug Manufacturer’s Savings Card Program or Discount Coupon Violate the Anti-Kickback Statute?

A drug manufacturer’s savings card program or discount coupon under which individuals who have Medicare Part D prescription drug coverage receive discounts may violate the Anti-Kickback Statute (“AKS”), unless the drug being purchased is statutorily excluded from Part D coverage.  The key here is that the drug must be excluded […]
June 21, 2017 Healthcare Fraud

Pharmacy Discount Programs Can Lead to a Violation of the False Claims Act

Retail pharmacies that offer a discount drug pricing program to consumers must charge Medicare the same prices for drugs that they charge consumers who participate in those programs. To do otherwise violates the False Claims Act (“FCA”). The specific question is whether a pharmacy that offers a discount drug pricing […]
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