The federal anti-kickback statute ("Anti-Kickback Statute") prohibits payments of remuneration between referring physicians and hospitals involving Medicare and other governmental payment programs. Violation of the law is a federal felony and can result in criminal and civil penalties.
The development of P4P programs is expensive and includes the same legal considerations that exist with any type of hospital-physician joint venture. The natural inclination is for a hospital to fund the development costs. If a hospital provides benefits to a group of referring physicians, however, the Anti-Kickback Statute may be violated.
The Anti-Kickback Statute is broad in its reach and is extremely complex. Because of its breadth, certain safe harbors have been adopted to protect certain activities. The analysis of the relationships in a P4P program is critical to assure that there is no exposure to anti-kickback penalties. Because P4P is so new, there is little direct guidance to the industry from the government.
Stark Law Exceptions and Anti-Kickback Safe Harbors:
(i) Electronic prescribing items and services; and
(ii) Electronic health records items and services exceptions.
