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Case Study
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Zimmer, Anti-Kickback Statutes: Civil Enforcement Of Fraud And Abuse (Case Study Sample)


Conduct a search of anti-kickback laws related research, and discuss their application to healthcare organizations. Using the following site, discuss the Zimmer case in view of anti-kickback statutes: Civil Enforcement of Fraud and Abuse. Discuss the practical implications of the decision taking into consideration current research.


Government Payment
The Anti-Kickback legislation in the United States of America is a law that was enacted with the sole intention of prohibiting exchange or offer thereof of anything valuable with the intention of influencing reward services or products in health care that are reimbursed by the federal government. The primary aim of this law is to prevent corruption and thereby protect beneficiaries of federally funded health programs. According to this legislation, it is illegal for anybody who willfully and knowingly makes an offer or seeks to receive a payment for referring someone for services or products that fall under the reimbursable federal health programs. Simply put, when one makes a referral for such services and or products, they should not seek payment otherwise such an action would be deemed illegal.
When the law was originally enacted, it aimed at protecting both the federal government and the patients from abuse and fraud on the system (Kazmier, 2015). However, some providers in the healthcare system raised concern that a blanket condemnation of the practice could discourage few arrangements that could be beneficial to both the government and the patients. As a result, the Congress made some exceptions that would otherwise fall in the category of violation of Ant-kickback laws but would not be liable to prosecution.
Overview of the Policy
A patient must be treated with a certain level of confidentiality and trust. Therefore, when they consult a physician who then recommended a certain drug, or recommends a certain medical procedure, the patient believes that such a recommendation has been done with the best interest considered. Unfortunately, in some cases, this is not always so. There are some health providers who will make recommendations for drugs or medical services for their own financial gain. For instance, a physician may engage and agree with a certain drug company, that for all patients with a particular ailment, the physician is to recommend the patient to purchase their drugs. In return, the physician gets some percentage commission from the sales realized. That is a kick-back, a bribe of some sort whe

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