Question

The 1987 “Anti-Kickback Statute” (MMPPA) prohibits giving of or receiving compensation in exchange for referrals for Medicare or Medicaid services or goods. Why is it fraudulent and subject to a charge of criminal conspiracy to pay referral sources from Medicare and Medicaid reimbursement? Does payment or receipt for referrals constitute “obtaining property from more than one source by fraudulent pretense,” or is it billing for services not rendered, or falsifying information or misrepresentation? Does it make a difference if either the referring source or the referral receiver has a financial ownership or interest in the other’s entity?

Answer 1

The AKS is a criminal statute that prohibits transactions intended to induce or reward refferals for items or services reimbursed by the federalhealth care programs.It is an anticorruption statute designed to protect federal health care program benefeciaries from the influence of money on refferal decisions on thus intended to guard against overutilization.incrase costs and poor quality services.

The AKS prohibits anyone from knowingly and willfully offering ,making,soliciting or receiving any payments in return for
1.reffering one person or entity for the furnishing of any item or services reimbursed by a federal health care programe
2.recommending or arranging for the ordering of any service reimbursed b a federal health care program.In other words ,accepting payments for refferals or for otherwise generating Medicare or Medicaid business is as illegal as offering or making such payments.

Congress established the Medicare or Medicaid program in 1965,soon thereafter certain unethical provider practices began to develop.Physicians began profiting from the federal government by making unnecessary patient refferals( in exchange of kickback) to particular facilities for meidcal services reimbursed by the federal health care programs,which result in rising costs.Problematic arrangements took various forms,including percentage lease agreements and payments of test interpretation fees to physician who reffered testing witout performing the interpretation themselves.
To combat these unethical practices,Congress passed the original version of te AKS in 1972.The statute made the receipts of kickback,bribes,or rebates in connection with items or services covered by Medicare or Medicaid programs a misdemeanor punishable by fine,imprisonment,or both.
Congress made next amended the AKS in 1987 when it passed the Medicare and Medicaid patient and program protection act(MMPPPA)which made two important changes.
1.MMPPPA granted to the office of Inspector General the authority to exclude from participation in various federal health care programs an individual or entity convicted of an AKS violation.

2.the legislation directed HHS to promulgate regulations that created additional exceptions to the AKS,reffered to as "safe harbors".

AKS iS agianst for the payments or reciepts for referrals constitute obtaining property from more than one source by fradulent pretense .
No,either the refferal source or refferal reciever gets financial benefit or interest in others entity causes to unnecessary trouble to the patients where the reffering source not even interpreting the patient for the need.
so both refferal source and refferal receiver benefiting on others entity.