The federal government is aggressive and particularly active in pursuing suspected violations of the Anti-Kickback Statute against healthcare providers, in particular home health care companies and hospice care providers. This type of zealous prosecution often results in harsh penalties for healthcare providers found to have committed a violation.

For example, a California based medical center agreed to pay over $1.6 million to resolve self-disclosed Anti-Kickback violations stemming from improper payments to physicians who invested in a joint venture ambulatory surgical center. That penalty was dwarfed, however, by the $24.5 million settlement a group of clinics and physicians in Alabama paid to settle Anti-Kickback and Stark Law allegations that the clinics kicked back a percentage of Medicare reimbursements for tests and procedures the physician group referred.

This trend toward stricter enforcement and larger penalties has been ongoing for years with no end in sight. In June 2014, HHS issued a special fraud alert identifying arrangements between laboratories and physicians as presenting a substantial risk of fraud and abuse under the Anti-Kickback Statute.