Fee Splits and Kickbacks: Know Them and Avoid Them

Course overview

Describe how healthcare fraud became a federal enforcement priority and explain the origins of fee-splitting prohibitions in chiropractic practice. Explain the rationale behind the corporate practice of medicine ban and how it extends to lay control over professional decisions. Identify why percentage-based marketing and management contracts typically constitute illegal fee-splitting under state law. Describe the federal Anti-Kickback Statute's prohibitions, penalties, and application to patient referrals involving federally reimbursed services. Apply key diagnostic questions to determine whether a business arrangement violates federal anti-kickback laws. Explain Stark Law's prohibitions on physician self-referrals and the designated health services covered under Stark II. Compare state and federal anti-kickback laws and evaluate the role of fair market value in identifying hidden referral compensation. Recognize how physician recruitment, diagnostic testing, and marketing arrangements can disguise illegal kickbacks. Describe safe harbors and Stark exceptions, including the bona fide employment exception protecting referral compensation. Explain vicarious liability and ostensible agency, and identify practice conditions that create shared liability among providers. Apply strategies to minimize ostensible agency liability when sharing office space or using independent contractors. Evaluate liability risks in coverage arrangements and summarize core principles for lawful patient referrals.