Playing by the Rules Kickbacks, Fee-Splits, and Self-Referral Law

Course overview

Trace the historical development of fee-splitting prohibitions and explain how courts and the AMA shaped early bans on corporate medical practice. Identify the legal consequences of fee-splitting violations using Illinois case law and recognize which professionals are subject to state fee-split prohibitions. Describe the federal enforcement landscape for healthcare fraud, including the agencies, penalties, and prosecutorial strategies used against kickback violations. Explain the statutory elements and intent requirements of the Anti-Kickback Statute and apply key questions to evaluate whether a referral arrangement is a violation. Analyze case scenarios involving referral compensation to determine potential Anti-Kickback violations and identify arrangements that serve legitimate non-referral purposes. Distinguish between the Anti-Kickback Statute and Stark Law, identify designated health services subject to Stark, and describe state-level self-referral prohibitions. Identify disguised kickback arrangements including lab payments and relocation agreements, and describe appropriate steps when facing a federal investigation. Explain how safe harbors developed in response to referral abuse and describe compliance requirements for employee, space rental, equipment, and personal services safe harbors. Analyze joint venture arrangements under the Anti-Kickback Statute, apply the 60/40 rules, and identify OIG-designated features of suspect ventures. Identify prohibited self-referral arrangements under Stark and describe the in-office ancillary services exception and group practice definition. Apply the 75 percent test and unified business standard to determine group practice qualification and describe restrictions on DHS profit distribution under Stark. Identify Stark exceptions for equipment rental, employment, personal services, and fair market value compensation, and evaluate common self-referral scenarios using the sample Q&A.