Can You Believe Your Doc? … Maybe
Segment # 400
My mother’s generation trusted authority regardless of whether it came in the form of a cop or a doc. Government and corporate interest groups capitalized on this by controlling the message by buying off legacy media. Thanks to the 1st Amendment this has changed dramatically. The movement towards independent thinking has been aided greatly by docuseries like”Dopesick and “Painkilers” and podcasts like Joe Rogan and Megyn Kelly. During the Biden Administration, hospitals and doctors had less to fear by laws on the books to stop this sort of activity. Now with Kennedy at HHS, Patel at FBI, and Bondi at DOJ, I think some folks may be re-assessing their activirties
Anti-Kickback Statute (AKS)
The Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)) criminalizes offering, paying, soliciting, or receiving any remuneration (e.g., money, gifts, or anything of value) to induce or reward referrals for services reimbursable under federal healthcare programs like Medicare and Medicaid. Violations are considered felonies and carry severe penalties:
Up to 10 years in prison.
Fines of up to $100,000 per violation.
Civil penalties under the Civil Monetary Penalties Law (CMPL), including fines of up to $50,000 per kickback and three times the remuneration amount
.
The statute also triggers liability under the False Claims Act (FCA), which penalizes submitting false claims to government programs. Violators may face additional fines and exclusion from federal healthcare programs
.
Anti-Kickback Act of 1986
This law (41 U.S.C. § 51 et seq.) addresses kickbacks in government contracting. It prohibits knowingly and willfully engaging in kickbacks involving government contracts, including subcontractor arrangements. Penalties include:
Criminal sanctions for knowingly engaging in prohibited conduct.
Prohibition of kickback amounts being included in contract prices
.
False Claims Act (FCA)
The FCA targets fraud against government programs by imposing liability for knowingly submitting false claims or causing such claims to be submitted. Kickbacks often lead to FCA violations because they result in fraudulent billing to government programs
.
Stark Law
The Stark Law specifically prohibits physicians from making referrals for certain designated health services payable by Medicare or Medicaid if the physician has a financial relationship with the entity receiving the referral. While narrower in scope than AKS, it complements anti-kickback measures by targeting self-referrals
.
Penalties for Violations
Violations of these laws can result in:
Criminal charges with prison sentences ranging from 5 to 10 years.
Monetary fines ranging from $25,000 to $100,000 per violation.
Civil penalties such as exclusion from federal healthcare programs and assessments of up to three times the kickback amount
.
These laws aim to ensure ethical practices in healthcare and government contracting while protecting taxpayers from fraud.
More than half of doctors receive industry payments, with some making millions
By Judith Garber | April 29, 2024
Judith Garber is a Senior Policy Analyst at the Lown Institute. She holds a masters degree in public policy from the Heller School of Social Policy and Management.
A recent study in JAMA finds that 57% of physicians received a payment from pharmaceutical or medical device companies over the past ten years. What are the implications of these industry payments?
Millions in payments
The JAMA study and related data from the CMS Open Payments database reveal a significant level of financial interaction between the healthcare industry and physicians in the United States from 2013 to 2022. Below is an analysis of the findings, highlighting the scope of these payments and their implications.
Key Findings on Industry Payments to Physicians (2013–2022)
Distribution of Payments:
The $12 billion in industry payments to U.S. physicians over nearly a decade underscores the pervasive financial ties between healthcare providers and the pharmaceutical/medical device industries. While transparency initiatives like Open Payments have shed light on these relationships, concerns about conflicts of interest and their impact on healthcare costs and patient trust remain significant challenges for the healthcare system.
The transparency that OpenPayments provides is incredibly valuable, but it’s just the first step in tackling financial conflicts of interest. Few patients have looked up their doctor to find out whether they are receiving payments. And as the Abbott panel story shows, government bodies may not take into account whether doctors have conflicts when they create advisory groups.
To combat this problem, there should be more stringent rules regarding industry relationships for doctors in leadership positions on panels or advisory groups, especially groups evaluating a specific product. More broadly, the government could consider limits on dollar amounts for general payments or a ban on lucrative “speaker deals,” which some government officials have warned as ripe for fraud.