United States v. Greber
Courts are usually utilized in enforcing the laws, which include health insurance regulations, among others. Dr. Greber, who was the accused person in the case United States v. Greber, was the founder of Cardio-Med, and was charged for offering financial kickbacks to physicians who referred patients to his company. The court pointed out that Dr. Greber violated the law by making payments that were aimed at inducing patients to use the services of Cardio-Med. The court confirmed the case as a felony and passed judgment, owing to the evidence given concerning the Medicare statute and the federal anti-kickback statute.
Dr. Greber’s case offered a different form of payment from the acceptable payment for professional services because it went against the federal anti-kickback statute. Kickbacks enable the health care providers to set up more services than they ought to offer while the federal government reimburse for the extra services. According to Wolper (2013), the anti-kickback statute impose a criminal penalty to anyone who deliberately solicits, or request payment in return for recommending individuals to purchase services for which payments are made through the Medicare or Medicaid programs.
Dr. Greber went against the appropriate way of paying for professional services because he persuaded physicians to utilize his organization’s services for a fee. Cardio-Med Company paid the Medicare bills, but when payments were made, the company forwarded a portion of the payment to the referring physician. The court claimed that Greber was guilty of violating the anti-kickback statute because his company requested for a recommendation fee, which was prohibited by the law. The court confirmed the judgment since the intention of the defendant was to encourage future referrals, even though the payments aimed at compensating the physicians for their professional services. The act was a violation of the Medicare statute.
Physicians are allowed to determine the laboratories that should carry out tests for the Medicaid patients. The company that undertakes the laboratory practices can then claim reimbursement from the federal government. However, in the public health care, paying for a referral is considered a crime, even when the percentage of the payment is within the Medicare’s guidelines. The anti-kickback statute perceives payment as anything that involves a monetary value, and if such payment is aimed at inducing physicians to utilize the company’s services, then the statute was breached. Thus, the court must have found Greber’s actions as a prohibited form of remuneration.
The percentage that Dr. Greber paid to the physicians does not matter, as what mattered was whether the law allows for compensating physicians for referral. The Stark Law forbids physicians from referring patients to certain designated health services that offer Medicare or Medicaid programs, for financial gain (Kinney, 2015). The law does not allow physicians to take any form of payment from providers or suppliers as a referral for Medicare and Medicaid patients. It prohibits the offer, as well as the payment to avoid unfair competition and corruption in the healthcare provision.
In the U.S. federal criminal code, all forms of crimes are categorized into either misdemeanor or felony, based on the level of seriousness of each crime (Siegel & Worrall, 2016). A misdemeanor crime involves offenses that aim at disturbing peace and is punishable by a sentence that does not exceed one year. Examples of misdemeanor crimes include assault, where the offender threatens to cause harm to another person, though he/she does not perform any act of harm. Theft can also be classified as a misdemeanor crime if the amount of money stolen is below $500. Other examples of misdemeanor crimes include drunken driving, traffic violations, burglary, perjury, and resisting arrest.
A felony crime incorporates violence of a higher magnitude than in a misdemeanor, where an offender is liable to an imprisonment that exceeds one year. A felony crime offender can also be punished with a death sentence (Siegel & Worrall, 2016). An assault can be considered a felony if the suspect is believed to have caused an actual bodily harm or the suspect was caught with a weapon, which was intended to harm the victim. An assault can also be termed as a felony if the accused person threatened the accuser by disguising his/her identity, or threatened the accuser by pointing a gun or shooting the victim. Other examples of felony include rape, murder, kidnapping, arson, grand theft, and selling illegal substances.
The federal government’s effort to eradicate frauds that occur in the Medicare program offers a challenge to providers, as well as payers, who strive to remain with the law. Changing Medicare fraud offenses from being a misdemeanor to a felony changes the type of sentence that an offender receives from the courts. A misdemeanor is punishable through paying a fine or serving a jail sentence that ranges from six months to one year (Siegel & Worrall, 2016). Dr. Greber had already paid the physician his share, thus, had already committed a felony crime. If he was caught while attempting to pay for referrals, he would have been charged with a misdemeanor. The anti-kickback violation is considered as a felony because it involves receiving huge amounts of money fraudulently through referrals. However, kickbacks have the capacity to create overutilization of healthcare resource, thus, draining the federal budget and, consequently, increasing the Medicare frauds. Doctors are likely to organize for superfluous tests in order to earn kickbacks.
The case United States v. Greber hihglighted an incidence where individuals have infringed the anti-kickback statute. The court stated categorically that direct cash payments done in exchange for referrals breached the Statute. However, the court failed to expound on what constitutes indirect payments. The percentage that Dr. Greber paid to the physicians does not matter, as the law does not permit for compensating physicians for referral. Dr. Greber’s case amounted to felony because it involved grand theft, which could have interfered with the federal budget.
Kinney, E. D. (2015). The Affordable Care Act and Medicare in comparative context. New York, NY: Cambridge University Press.
Siegel, L. J., & Worrall, J. L. (2016). Introduction to Criminal Justice. Boston, MA: Cengage Learning.
Wolper, L. F. (2013). Physician practice management: Essential operational and financial knowledge. Burlington, MA: Jones & Bartlett Learning.