First, an advertisement for a similar arrangement promoted by a pharmacy competitor promises Centers savings in costly staff positions and relief of burdens imposed on existing staff. In effect, the Proposed Arrangement offers Centers the opportunity to shift payroll or contractual costs to the Pharmacy. Second, we infer that one purpose of the free services is to induce referrals. Transplant patients need lifetime pharmacy services. The services required by the patients are extremely expensive and will generate significant revenue for the Pharmacy.
Immunosuppresive therapy is critical to the success of a transplant.
Depending on risk factors and therapy, a significant number of transplant recipients undergo one or more episodes of rejection during the year immediately following transplantation. Common sense suggests that a Center's recommendation of a preferred outpatient pharmacy to a patient will be given great weight. In short, the Centers will exercise substantial influence over a significant source of revenue for the Pharmacy. One purpose of the anti-kickback statute is to protect patients from inappropriate medical referrals by providers who may be unduly influenced by financial incentives. The statute seeks to ensure that referrals will be based on sound medical judgment and that providers will compete for business based on quality and convenience, instead of paying for it.