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Marketing to Medicare or Medicaid Beneficiaries: What You Can and Cannot Do
The federal Anti-Kickback Statute ("AKS") 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. The prohibited activity is a two-way street, with both the payer and the receiver equally culpable. What constitutes "any remuneration," however, is a gray area. While the statute provides that remuneration includes "any kickback, bribe or rebate," it does not define these terms. Further, there is a prohibition against remuneration "directly or indirectly, overtly or covertly, in cash or in kind."
Violation of the AKS is a felony with a maximum fine of $25,000 and imprisonment up to five years, or both. Conviction results in automatic exclusion from federal health care programs. The Office of the Inspector General ("OIG") may initiate administrative proceedings based on a violation of the AKS and impose Civil Monetary Penalties ("CMPs") or exclude the offending party from federal health care programs.
The AKS includes both statutory exceptions and regulatory safe harbors. The safe harbors relevant to a discussion of marketing to Medicare/Medicaid beneficiaries include: (1) waiver of beneficiary coinsurance and deductibles by hospitals and selected other providers, or (2) increased coverage, reduced cost-sharing or reduced premiums offered by health plans.
The Civil Monetary Penalties Law ("CMP Law") prohibits offering or transferring remuneration to a Medicare/Medicaid beneficiary that the person knows or should know is likely to induce selection of a particular provider, for which payment may be made in whole or part by Medicare or Medicaid. "Remuneration" is defined as any transfer of items or services for free or other than fair market value. Violation of this CMP may be penalized by a civil fine of $10,000.00 per item or service. In addition, the OIG may administratively exclude the party from federal health care programs.
This webinar will scrutinize these laws with a view to understanding these illegal inducements and changes made by Obamacare. The program will also examine guidance provided by the Department of Health and Human Services and the OIG. Finally, the program will look at potential risk areas.
The Medicare/Medicaid Fraud and Abuse Anti?Kickback Statute (the "Statute") is alive, still with us and as viable as ever. The Statute provides that the offer or payment, as well as the solicitation or receipt, of "any remuneration" in exchange for referrals of any good, facility, service, or item for which payment may be made in whole or in part under Medicare/Medicaid is prohibited. Likewise, the Civil Monetary Penalties Law prohibits offering or transferring remuneration to a Medicare/Medicaid beneficiary that the person knows or should know is likely to induce selection of a particular provider.
Overview of the webinar
To provide the attendee with an understanding of the risk of marketing to Medicare and Medicaid beneficiaries and the potential for violating the federal Anti-Kickback Statute and/or the Civil monetary penalties law. The presentation will also provide attendees the tools necessary to protect themselves and their organizations from federal and state enforcement efforts under these laws.
Who should attend?
- Hospital Executives, particularly CEOs, COOs, CFOs, CNOs and CMOs
- Nursing Home Executives
- Physicians
- Physician Practice Managers
- Durable Medical Equipment Supplier Executives
- Other Healthcare Provider Executives
Why should you attend?
If your organization, be it a hospital, physician practice, DME provider, or any other provider offering healthcare services or supplies, engages in marketing its product or services, care must be taken to ensure that the organization does not run afoul of the Anti-Kickback Statute, OIG advisory opinions, and OIG compliance guidance to help you understand what you can and cannot do with engaging in healthcare marketing.
When you finish this program, you should have a good understanding of what you can and cannot do with regard to marketing activities. The penalties for not conducting a marketing program correctly can be severe, including exclusion, civil monetary penalties, and even criminal prosecution.
Attend this webinar and learn how to protect yourself and your organization.
Faculty - Mr.William Mack Copeland
William Mack Copeland, MS, JD, PhD, LFACHE, practices health care law in Harrison, Ohio at the firm of Copeland Law, LLC. He is also president of Executive & Managerial Development Group, a consulting entity providing compliance and other fraud and abuse related services. A graduate of Northern Kentucky University Salmon P. Chase College of Law, Bill is a frequent author and speaker on health law topics. Copeland is a member of the American Health Lawyers Association, American, Ohio and Cincinnati Bar Associations and is a life fellow in the American College of Healthcare Executives. He was awarded the American College of Health Care Executives Senior-Level Healthcare Executive Regent’s Award in 2007. He can be reached at (513) 290-2458 or wmc@copeland-law-llc.com.