This session will provide an overview of the Anti-Kickback Statute (AKS) and its prohibitions, as well as the available safe harbors. It will highlight how AKS violations can raise concerns under the False Claims Act (FCA), and assess the enforcement activities that put participants at risk. Recent cases will be reviewed to illustrate their potential impact on participants. The presentation will delve into the AKS, focusing on prohibited activities and the exceptions outlined in the Act. Case law, especially early cases that set the foundation for judicial interpretation, will be examined. The session will also explore the "safe harbors," which protect payment practices from criminal prosecution, civil monetary penalties, or exclusion from Medicare and Medicaid programs. The presentation will recount Mr. Weinbaum's entire ordeal, offering valuable insights, recommendations, and colorful anecdotes. It will address documentation, verbal and written correspondence with physicians and attorneys, disclosure of facts, hospital governing boards and medical staff leadership involvement in financial arrangements, and the potential exposure created by the administrative team's management style. Register, https://conferencepanel.com/conference/the-anti-kickback-statute-perspectives-from-a-whistleblower-lead-counsel-and-an-anti-kickback-case-defendant

1. The Anti-Kickback Statute
Perspectives from a Whistleblower
Lead Counsel
and
an Anti-Kickback Case Defendant
© Copeland Law, LLC
Presented By
William Mack Copeland, MS, JD, PhD, LFACHE
and
Barry Weinbaum
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2. Objectives
To provide an overview of the Anti-Kickback
Statute, its elements, what it prohibits, and how
it works;
To review United States v. Weinbaum by the
defendant in the case.
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3. FEDERAL ANTI-KICKBACK STATUTE
The Statute prohibits the offer or
payment, as well as the solicitation or
receipt, of "any remuneration (including
any kickbacks, bribe, or rebate)" in
exchange for referrals.
Two-way street: both the payer and the
receiver equally culpable.
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4. ANTI-KICKBACK EXCEPTIONS
A discount or price reduction to the provider
that is properly disclosed and appropriately
reflected in costs claimed by the provider;
Payments by an employer to a bona fide
employee;
Group purchase arrangements; and
The safe harbors.
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5. The Medicare and Medicaid Patient and
Program Protection Act of 1987
It may be viewed as an effort to respond to
the concerns of health care providers that
many relatively innocuous, or even beneficial,
commercial arrangements are technically
within the statute’s scope and hence may be
subject to criminal prosecution.
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6. Safe Harbors: Recurring Themes
1. Not based on referrals.
2. Fair Market Value.
3. Written Agreement.
4. No less than one year.
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7. United States v. Weinbaum
 Brief Background:
 Alvarado Hospital Medical Center
311-bed hospital
East San Diego County
 Relocation agreements
99 agreements in 10 years (1992 to 2002)
 “Father of Case” – Dr. Paul ver Hoeve
Medicare fraud for over-billing
Brought kickback allegations in exchange for
leniency
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8. Lessons Learned
How Can You Be Accused of
Breaking the Law When You Believe
What You Were Doing Was Legal?
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9. Advice & Recommendations
 Documentation
 Material disclosure of facts and attorney/client interaction-
documenting emails, phone conversations
 “Its OK to make mistakes”- Not against the law
 Documenting corrective action
 Transparency of files/witness tampering/obstruction of justice
 NEVER SHRED DOCUMENTS
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10. Advice and Recommendations
 Do you do business with people who demonstrate integrity and who
you can trust?
 Does your GB and MEC endorse and review hospital financial
arrangements with physicians?
 Sticking out in the community with your business practices. Can
your intent be questioned?
 Violating your own policy and procedure
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11. Advice and Recommendations
Management staff and Organization
 Delegating/Who is doing what?
 Being a precise communicator
 Being a good listener and observer and looking for “red flags”
 Disgruntled physicians and Qui-Tam Act
 Staying focused-Relocation agreements were 1% of my time but 100%
of my exposure!!
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12. RECOMMENDATIONS
• Develop a good compliance program that is a living document.
• Periodically conduct internal audits of billing and payment practices.
• Review all contracts with physicians and other providers, paying close
attention to contracts with entities in a position to refer.
• Develop a training program to teach compliance to employees and
contracted personnel.
• Understand and comply with the law and regulations.
• Create a culture of compliance strongly supported by top management.
• Maintain quality of care.
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13. CONCLUSION
 Healthcare fraud and abuse laws are
very complicated and complex.
 Nevertheless, you are responsible for
compliance.
 Get good advice.
 Risks cannot be eliminated, but they
can be mitigated.
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14. If there are any further questions we could not answer
today, please feel free to contact us by calling.
513-290-2458 (Copeland)or email at
wmc@copeland-law-llc.com;
(619) 246-7247 (Weinbaum) or email at
Weinbaumbarry@gmail.com
Questions
Register Now
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