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Florida Physician Self-Referral Lawyer

Ethics directly impact patient care in the medical field and should give providers a deep sense of responsibility. Those who suspect a healthcare provider prioritizes profits over patients face a dilemma in knowing when to report potential fraud.

Yormak Disability Employment & Disability law firm offers board-certified expertise in employment law. When reporting potential fraud, we can guide you through the legal process, protect your rights, and help protect your professional reputation. Contact us for a free consultation.

Blowing the Whistle on Healthcare Violations

Federal laws prohibit physicians from referring patients to specific services payable by Medicare or Medicaid if the physician (or an immediate family member) has a financial relationship with the entity providing the services.

Moreover, exchanging anything of value to reward the referral of a federal healthcare program business is also considered fraud. These serious violations contribute to rising healthcare costs and can compromise patient care.

Whistleblowers — often healthcare providers who become aware of fraud or patients who witness the act firsthand — play a crucial role in maintaining the integrity of our healthcare system.

Specific laws prevent conflicts of interest and healthcare fraud by regulating financial relationships between physicians and entities providing designated health services.

The False Claims Act

The False Claims Act (FCA) is a federal law that allows healthcare providers to sue those who commit fraud against government programs. It’s a powerful tool against healthcare fraud, including the Stark Law and Anti-Kickback Statute violations.

Under the FCA, whistleblowers can file a lawsuit on behalf of the government and potentially share in any recovered damages. This is known as a “Qui Tam” lawsuit.

Filing a Qui Tam action is more complex than a regular lawsuit. It has special steps and strict deadlines. That’s why it’s crucial to have an experienced Florida attorney guide you through the process.

Whistleblower Rewards

If a Qui Tam action is successful, whistleblowers may be entitled to a significant reward. Under the False Claims Act, they can receive between 15% and 30% of the total recovery.

These rewards can amount to a substantial sum, especially in cases where fraud against the government is extensive. In a recent legal case, a violation of referral laws in Florida led to a considerable settlement, with a whistleblower awarded $20.8 million for their crucial role in exposing the malpractice.

This case highlights the importance of whistleblowers and encourages healthcare providers to come forward with credible information about fraud to help protect government programs’ integrity and ensure unethical activities are not overlooked.

Federal Stark Law

Established in 1989, the Stark Law bans physician self-referrals for designated health services for Medicare and Medicaid patients. In other words, the Stark Law stops physicians from referring patients to health service providers when they have a financial interest in that provider.

Federal Stark Law Exceptions

Stark Law exceptions enable specific financial arrangements between providers, but only under strict rules. Some criteria for determining the legality of a healthcare arrangement include:

  • Compliance with the requirements outlined in the Stark Law regulations.
  • Not involving prohibited referrals or payments for designated health services.
  • Having a commercially reasonable and fair market value arrangement.

Federal Stark Law Violations

Stark Law violations can lead to hefty civil penalties, repayment of claims, and exclusion from Medicare and Medicaid programs. Providers found violating the Stark Law may be required to refund any Medicare/Medicaid reimbursement for illegally referred services.

As a strict liability statute, there is no burden for proof of specific intent to violate the law. This means that providers assume the burden of understanding the scope of the Stark Law because they can be held accountable regardless of whether the violation was intentional.

Florida’s Patient Self-Referral Act

Florida’s Patient Self-Referral Act is similar to the Stark Law but covers more ground. It applies to all types of payments and stops doctors from referring to labs, therapy, and radiology services where they have a financial interest in those clinics.

This state law seeks to prevent referral practices that may hinder competition in the healthcare service market and potentially lead to the overexploitation of patients.

Florida Self-Referral Law Exceptions

Under state law, exceptions to this law encompass scenarios not considered referrals. Exceptions provide leeway for financial relationships that do not present a financial danger or control over patient referrals.

For instance, if a physician is part of a group practice (like a team of doctors working together), they can refer patients to receive certain services within their group.

This exception is known as the Florida In-Office Ancillary Services Exception (FL IOASE). It’s allowed because these services are for the patients of that specific group practice, not for the physician’s gain.

Florida Self-Referral Law Violations

Florida Self Referral Law violations may result in fines, compensation, and exclusion from state healthcare programs, including Medicaid and Medicare. In some cases, criminal charges may be levied.

The Anti-Kickback Law

The Anti-Kickback law prohibits exchanging or paying for patient referrals to services covered by government-funded healthcare programs such as Medicare and Medicaid. It ensures that patient care, not profit, is the primary focus in healthcare decisions.

In simpler terms, healthcare providers cannot offer, pay, solicit, or receive any bribe to influence patient referral. This includes cash incentives and any other type of reward, such as gifts, discounts, or services.

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The Stark Law and Anti-Kickback Statute stop physicians from making self-referrals that can harm patient care and raise healthcare costs. At the same time, the False Claims Act protects whistleblowers’ rights and allows for financial rewards when they red-flag fraud.

Filing a Qui Tam action under the FCA requires legal knowledge and experience. We work to maximize the potential for a successful outcome and make sure your rights are protected. You don’t have to face this alone. Contact Yormak Employment & Disability Law for a free consultation.

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