AFFA WILL ADHERE TO THE FOLLOWING FEDERAL STATUTES & COMPLIANCE RULES FOR
The Medicare and Medicaid Patient Protection Act of 1987 is referred to as the Anti-kickback Statute. The statute provides criminal penalties for certain acts impacting Medicare and Medicaid reimbursable services. Particularly, the statute prohibits the offer or receipt of certain remuneration in return for referrals for or recommending the purchase of supplies and services reimbursable under government healthcare programs. Advocates CANNOT offer to give money back to individuals or physicians, EVER.
The Medicare anti-kickback statute prohibits (1) the willful solicitation or receipt of remuneration in return for referrals of Medicare patients for any service for which payment may be made in whole or in part under Medicare or a State health care program, and (2) the offer or payment of remuneration to induce such referrals. Persons who violate the statute shall be guilty of a felony and upon conviction, shall be fined not more than $25,000 or imprisoned for not more than five years, or both. Thus, the Act explicitly prohibits any remuneration knowingly and willfully offered or paid to induce, or solicited or received in return for, Medicare or Medicaid patient referrals.
Most providers are aware that paying kickbacks for referrals is a felony under the Anti-kickback Statute (AKS), 42 U.S. Code § 1320a–7b (b)(1)1. You can get into very big financial trouble, and lose your license. Unlike Stark law, 42 U.S.C. 1395nn., which only applies to physician referrals, the AKS applies to remuneration paid to anyone for arranging in whole, or in part, the furnishing of services or items covered by a federal healthcare program. This means the AKS is broad enough to cover payments to a sales force which is paid on commission. The actual wording of the statute reads:
Whoever knowingly and willfully solicits or receives any remuneration (including any kickback, bribe or rebate) directly or indirectly, overtly or covertly, in cash or in kind—in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a Federal healthcare program, or in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under a Federal healthcare program, shall be guilty of a felony and upon conviction thereof, shall be fined not more than $25,000 or imprisoned for not more than five years, or both.
Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity providing designated health services (“DHS”) if the physician (or an immediate family member) has a financial relationship with that entity. (read entire article). Advocates CANNOT offer to pay a physician for conducting any of the tests. A physician CANNOT become an Advocate unless, they are retired and no longer practicing medicine. A physician CANNOT be paid to offer the test to their patients.
To protect consumers, the law is very specific about what AFFA Advocates may or may not do. For example:
Advocates CANNOT market through unsolicited contact, including:
- Telemarketing calls, including voice mail messages, emails or texts
- Door-to-door solicitations, including leaflets or flyers at your home or car
- Approaching Medicare beneficiaries in common areas, like parking lots, hallways, lobbies, and sidewalks.
Advocates CAN speak with a client on the phone only if the client calls you first.
Advocates CAN go to client’s home only if you have previously been invited by client to do so
Advocates CANNOT dress up as a medical provider of any type unless they are a licensed medical provider.
AFFA has taken the financial obligations to make sure all employees are statutory employees who are paid a salary with tax withholdings and who are also offered benefits. Section 530 of the Internal Revenue Code (IRC) includes a safe harbor provision relating to the classification of workers as independent contractors. Under this provision, a company is not liable for employment taxes if it can demonstrate that a reasonable basis for treating workers as independent contractors exists, and if the employer can meet three reasonable basis standards.
The Affordable Care Act includes a safe harbor for affordability for employee health care coverage. If it’s not affordable, you can’t be held to a responsibility to pay for it.
Another safe harbor provision is the IRS Special Accounting Rule that allows employers to treat non-cash fringe benefits provided in November or December as being provided in the following year.
The domestic production activities deduction for U.S. manufacturing businesses provides a safe harbor provision that allows businesses to take this deduction if at least 20 percent of the total costs are the result of direct labor and overhead costs from US-based operations
AFFA ON COMPLIANCE
AFFA Has a No Nonsense Compliance Policy
AFFA has and will continue to require strict adherence to regulatory authority guidelines from its leadership, advocates, corporate office employees, vendors and anyone participating in AFFA business. The systems and procedures instituted by Mr. Irving Gilbert will be the example for all other companies operating in this space to emulate. In a nutshell, at AFFA, we will lead and let the others follow.BUSINESS OPERATION