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I. The Anti-Kickback Statute One purpose of the anti-kickback statute is to protect patients from inappropriate medical referrals or recommendations by health care professionals who may be unduly influenced by financial incentives. Section 1128B(b) of the Social Security Act (the Act) makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce, or in return for, referrals of items or services reimbursable by a Federal health care program. When remuneration is paid purposefully to induce or reward referrals of items or services payable by a Federal health care program, the anti-kickback statute is violated. By its terms, the statute a scribes criminal liability to parties on both sides of an impermissible "kickback" transaction. Violation of the statute constitutes a felony punishable by a maximum fine of $25,000, imprisonment up to 5 years, or both. Conviction will also lead to exclusion from Federal health care programs, including Medicare and Medicaid. OIG may also initiate administrative proceedings to exclude persons from the Federal health care programs or to impose civil money penalties for fraud, kickbacks, and other prohibited activities under sections 1128(b)(7) and 1128A(a)(7) of the Act. II. Remuneration From Laboratories to Referring Physicians Arrangements between referring physicians and laboratories historically have been subject to abuse and were the topic of one of the OIG's earliest Special Fraud Alerts. 1 In that Special Fraud Alert, we stated that, "[w]henever a laboratory offers or gives to a source of referrals anything of value not paid for at fair market value, the inference may be made that the thing of value is offered to induce the referral of business.

Westhill Consulting Insurance - How to Avoid Health Care Fraud Mail-order medications Patients who buy drugs through mail-order companies could be rolling the dice with their health says Dr. Deborah C. Peel, a physician and founder of the nonprofit Patient Privacy Rights. There's a high probability in many cases that these drugs are counterfeit Peel added. "And you don't ever know because the fraudulent tablets look just like the real ones," says Peel. She says ordering from companies that specialize in mail-order sales that are not affiliated with a legitimate insurance company, especially from foreign countries, can be very risky. Not only could the quality be questionable, it could also be illegal. "But people are desperate because we're being so grossly overcharged for medication," she says. Peel says you can lessen costs by buying generic. You can spot it by: the best thing to do is to keep away from buying drugs from foreign or obscure pharmacies. And if you decide to go with the mail-order route, just stay with U.S.-based companies because if it's a U.S. company, you can report the health care fraud to the Food and Drug Administration while if it's a foreign company, there's little that can or will be done. False product claims According to the Federal Trade Commission, millions fall victim each year to false miracle cures. Especially vulnerable are victims of debilitating and potentially deadly illnesses such as cancer, multiple sclerosis, HIV and AIDS. The FTC website says scammers take advantage of people with a grim diagnosis such as cancer and "promote unproven - and potentially dangerous - substances like black salve, essiac tea, or laetrile with claims that the products are both 'natural' and effective." But, say physicians and other experts, simply because something is advertised as "natural" doesn't mean it works. And while a patient is experimenting with bogus treatments, he or she can squander the opportu

The needs of elderly parents can surprise even those who are prepared, but you don't have to support your family alone Adult children of older parents should prepare financially for the costs of care and travel. Photograph: Alamy We all want to age like the late Pete Seeger, who celebrated his 90th birthday performing onstage in front of thousands of adoring fans of all ages at Madison Square Garden, and went on to entertain the Newport Jazz Festival audiences a few months later. In our pragmatic moments, we know that the odds of living that long and in such good health aren't in our favor. We know we need to plan not only to live longer but perhaps to spend more time in costly nursing homes or care facilities. It's not just ourselves we have to worry about. Failing to develop a plan to help our parents in their final years could deliver a similar kind of blow to our emotional and financial wellbeing. In the last few months, I've watched three friends, ranging in age from their 40s to the early 60s, scramble to resolve non-medical problems for their parents. In all cases, that meant forking out on costly airfares to be there in person; in one case, it required money to hire a new accountant. "I've always been aware that at some point, there would be an emergency, but I had assumed it would be a stroke or something, not this," one told me, ruefully. A recent US Trust survey revealed that while about half of all Americans have planned for their own long-term care needs, on

Charging you for help getting new insurance Someone contacts you, offering to help you navigate the Health Insurance Marketplace for a fee - or saying that you need a new insurance card now or you'll have to pay a penalty. Regardless of the set-up, their goal is to get your bank account or credit card number. Don't give your information. The people who offer legitimate help with the Health Insurance Marketplace - sometimes called Navigators or Assisters - are not allowed to charge you. In fact, you can't pay them. What's more, you don't need to buy a special insurance card, or pay any penalties for not buying one, either. Bottom line: Never give your money or your information to anyone who contacts you. Medicare cards Someone gets in touch, saying you need a new Medicare card because of "Obamacare." They tell you that you'll lose Medicare coverage if you don't pay a fee for a new card or give them your Social Security number and bank account or credit card number. Not true. The Affordable Care Act doesn't say you need a new Medicare card, or another health insurance card. Nor does the law say you'll lose Medicare coverage. Don't give your personal or financial information to anyone who contacts you. When in doubt, call 1-800-MEDICARE, before you give anyone your money or information. Medical discount plans Someone contacts you, offering discounts on health services and products. They might say the discount plan will save you money and that it meets the minimum coverage required under "Obamacare" so you won't have to pay a penalty or look at other plans. Medical discount plans are not health insurance. Sometimes, medical discount plans illegally pretend to be insurance. The only way to know is to ask specific questions and not pay until you read the terms. Most medical discount plans are a membership in a "club" that claims to offer reduced prices from certain doctors, certain pharmacies, and on some procedures.