Most people considered a kickback a bribe paid by an entity in exchange for a referral that resulted in a transaction or a contract. The interesting part as in the case below is that the bribe doesn’t necessarily have to be in cash. For example, not collecting co-payments from a patient may be interpreted as a kickback. In this particular case the Health Alliance of Greater Cincinnati and former member Christ Hospital agreed to pay a total of 108 million to settle a False Claims Act lawsuit alleging what the U.S. Justice Department called a “pay-for-play” scheme for cardiologists. The government’s case is simple as they contend that Christ Hospital had a practice of scheduling cardiologists at its diagnostic unit based on how much business they brought to the hospital. Cardiologists in turn billed for these diagnostics procedures and captured new patients. The case was brought to the government’s attention by a whistle-blower who will receive 23.5 million for his initiative. More than likely this was a case were the people involved didn’t think anything about their own practices. Now I ask you; how many times have you made decisions based on the number of referrals you receive? Next question; can you afford these types of settlements? Based on the current environment I would recommend the following preventive measures: 1. Have an outsider look at your practices. Many times we are so used to what we do that we do not perceive what could be a flaw in our Practices. 2. Develop a Compliance Plan customized to your Practice. Again, there are many generic plans available but do you know what is applicable to your Practice? 3. Implement the Compliance Plan. Paying for papers and binders do not constitute a defense.