Stark and Anti Kickback

STARK LAW & AKS LAW (Anti Kickback Law)


If you mix some mild antibiotic, a little dab of dog parasite medicine (Ivermectin) and a bit of this and that, your Rosacea may clear up.  You can’t get this at a drug store but I have a partner pharmacist who formulates this.  We can bill for it and most of the time it gets paid.  …. Is this legal ?  The profit is tempting.  Three dollars worth of chemicals, the cost of the tube and a few minutes labor and a $ 100 package exists.  Studies do show it may work.  Is it a Stark violation ?  Is it an AKS (anti kickback statute) violation ?  Is the science strong enough to justify the Rx ?  Would you prescribe it if you had no financial interest ?  Is this a Medical Board issue ?   There are state laws, medical board rules and insurance contract standards that apply but most dangerous are the federal laws that protect federal payor programs.  The complexity of laws and regulations often trip up an honest practitioner and our office knows the rules and protects you.

Do you feel safe because “Well I contacted the best medical lawyer in Los Angeles and he told me …..”.   Well don’t be so certain that you are safe.  Here are some recent press releases from the United States Department of Justice.

Fifteen Texas Doctors Agree to Pay over $ 2.8 Million to Settle Kickback Allegations

Flower Mound Hospital to Pay $18.2 Million to Settle Federal and State False Claims Act Allegations Arising from Improper Inducements to Referring Physicians

Those 15 doctors and the hospital likely had the best medical lawyers available to review their work.  We take a very conservative approach to medical-business ventures.  We often disagree with the legal opinions that read: “This opinion is no guarantee …”.   The lawyer disclaimers are red flags because although we admit that many of these aggressive practices are lucrative and successful, the failures are devastating to the physicians involved.

The Stark Law developed by our local Congressman, Pete Stark.  The Stark Law is also known as the Physician Self-Referral Act and unless you knew Pete Stark personally, that is the more descriptive name. The U.S. Code citation is 42 U.S.C. 1395 et seq..

As you read the Stark Law your head can spin. Can you make DHS Medicare referrals to a family member ?  What if it is a lithotripsy machine ? Is there an exception ? What about small towns when other treatment facility options are miles away ? Who is covered by this “physician” law ? Does it cover Doctors of Osteopathy, Dentists ? What about Pharmacists ? What about Chiropractors ?

Equally dangerous is the “AKS”. This is the federal anti-kickback statute. The Anti-Kickback Statute again focuses on referrals. This includes kickbacks for product, medical device, pharmaceutical and services kickbacks. An example are the recent string of arrests when a physician gave free samples of pain relief cream to a patient and then recommended a formulated product from a pharmacy. The physician had a complex scheme of reimbursement which the doctor’s attorney thought avoided Stark statute and Anti Kickback statute problems. The federal prosecutors disagreed.

The bottom line is this.  If you are a physician and you are making any money or have any relationship to other entities to which you refer – get legal advice. Bear in mind that with Stark law and other anti kickback statutes, our office is more conservative than many other practices.  Many of these businesses involve grey areas of law and it is our goal to put your safety and your license first.  We are not always right but we want our clients to sleep at night.  An example are the urologist / catheter arrangements where the MD’s seem to be seller and distributor of the catheters but fulfillment is by a third party (which makes the bulk of the profit).  These have often survived scrutiny but we use the “walk like a duck” approach and have unequivocally recommended against this grey area business arrangement.

If you are seeking a second opinion we can help.  If you are being sued or criminal charged for self dealing violations (or any type), Daniel Horowitz is a certified Criminal Defense Specialist (State Bar of California Board of Legal Specialization).

Call our Medical License & Criminal Defense Lawyers at (925) 283-1863 

or Fill Out our 1 Page Contact Form (click below)


Dan Russo


Dan Russo experienced jury trial attorney and criminal defense specialist featured at his law office in Vallejo california pink shirt and tie with law books from his vallejo office behind him.

Criminal Defense Specialist Dan Russo



Dan Russo is a trial lawyer extraordinaire !  Dan Russo been lead counsel has over 200 jury trials. 

Dan Russo is a Criminal Defense Specialist, certified by the State Bar of California Board of Legal Specialization for over 30 years.   Dan Russo has been a law school associate professor and a chapter reviewer for the leading criminal defense “bible” in California.

Physicians facing medical board accusations or medical-criminal investigations (e.g. medical fraud, Stark law violations) trust Daniel Russo to provide a defense that is well planned, forward thinking and aggressively applied.

Lawyers in Lafayette

Dan Russo works with a team of separate but affiliated lawyers at Lawyers in Lafayette.  Dan staffs each case with a custom team that is specifically designed to meet your needs.   If you have a business issue she has a paralegal with a high quality MBA.  If you have international issues, Daniel Horowitz has litigated cases throughout the world (including Ukraine, Israel, Cyprus, Canada, The Netherlands).

The team has two real estate brokers and two former top District Attorneys.   Whatever the issues are in your case, Carmela can lead a team that understands the issues and your concerns.

When Dan Russo takes your case you can be certain that the opposition knows that he will never back down from what is right.  With Lawyers in Lafayette on his team, Dan Russo has the advantage of incredible depth and experience to support his exceptional advocacy.

Trial Lawyer for Civil & Criminal Cases e, Call Dan Russo  (707) 644-4004

Dan Russo at press conference on high profile kidnap case

Criminal Defense Specialist


Criminal Defense lawyer certified as a specialist in criminal law

Criminal Defense Specialist


 To legally advertise as a criminal defense specialist, the attorney must pass a written test and undergo extensive peer review by other criminal defense attorneys, judges and prosecutors.  If you had a serious medical condition wouldn’t you seek the services of a specialist?  The same is true in criminal defense.  A criminal defense attorney who is a general practitioner will rarely have the expertise to provide you with the best defense against criminal charges.

Representative cases going to trial include physician healthcare fraud, chiropractic healthcare fraud, attempted murder, murder among many others !



If you have a heart problem would you go to a foot doctor?  Of course not.  But many attorneys advertise as “CRIMINAL DEFENSE LAWYER” and some (without State Bar approval), call themselves “CRIMINAL DEFENSE SPECIALISTS”.  But are they ?   The specialist certification requires academic achievement, trial skills and certification from other attorneys.  Unlike flashy advertising claims, the State Bar of California Board of Legal Specialization certification is an objective, earned achievement.  Only a few hundred attorneys in the entire State of California are certified criminal defense specialists.

Both Daniel Horowitz and  Carmela Caramagno are criminal defense specialists certified by the State of California Board of Legal Specialization.   Tom Kensok is a former Assistant District Attorney who was lead counsel in over 100 serious felony trials.  Oksana Tsykova is a National Trial Lawyer “Top 40 Under 40” award recipient.


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Criminal law is Trial law.   You might make a deal but an attorney who takes a “dump truck” approach to criminal cases is a disaster for the client.  Daniel Horowitz has the credibility of 200 + jury trials.  If you make a deal it is negotiated from a position of strength.  Daniel Horowitz has national recognition as a legal commentator on network shows such as Nancy Grace but he is relaxed and informal with his clients.

horowitz in t shirt outside martinez california courthouse with security signs on metal and glass doors


The types of cases that Daniel Horowitz has recently taken to trial may help you in deciding whether his office is a good fit for your case.

  • Felony Vehicular Manslaughter
  • Major Drug Conspiracy
  • Attempted Murder
  • Murder
  • Dissuading a Witness
  • Felony DUI with Great Bodily Injury
  • MS-13 Gang Conspiracy
  • Family Affiliated Mafia Gang Conspiracy
  • Medical Fraud
  • Insurance Fraud



Trial Attorney Oksana Tyskova

Oksana Tyskova


photo of oksana tsykova

Oksana Tsykova

Oksana Tsykova was raised by two physicians and focuses her practice on lawyer physician legal issues.  Her work for physicians including medical group contracts, peer review and complex federal investigations. Oksana is an experienced trial attorney with a strong background in criminal defense.   Oksana is the daughter of two medical doctors and she enthusiastically and with deep understanding fights for physician rights.  Oksana has extensive experience with Physician Visa issues.  The Marin County Superior Court Criminal Conflicts program has retained her as the expert consultant for their cases.


    CALI Excellence for the Future Award- Legal Research and Writing I and II
    CALI Excellence for the Future Award- Civil Litigation: Pre-Trial Phase
    Witkin Award for Academic Excellence- Trial Advocacy
    Witkin Award for Academic Excellence- Alternative Dispute Resolution
    Winner- Annual Bernard L. Segal Cross and Close Competition
    CALI Excellent for the Future Award- Advanced Trial Advocacy
    Witkin Award for Academic Excellence- Competition: Mock Trial



  • District of Columbia Bar
  • California State Bar
  • American Bar Association
  • Marin County Bar Association
  • Contra Costa County Bar Association
  • San Francisco Bar Association
  • American Immigration Lawyers Association
  • United States District Court Northern District of CaliforniaLawyers in LafayetteOksana works with a team of separate but affiliated lawyers at Lawyers in Lafayette.  Carmela staffs each case with a custom team that is specifically designed to meet your needs.   If you have a business issue she has a paralegal with a high quality MBA.  If you have international issues, Daniel Horowitz has litigated cases throughout the world (including Ukraine, Israel, Cyprus, Canada, The Netherlands).  Oksana is fluent in Russian and Ukrainian.  She also litigates high stakes immigration cases.The team has two real estate brokers and two former top District Attorneys.   Whatever the issues are in your case, Carmela can lead a team that understands the issues and your concerns.



A Client Focused Law Practice

Custom Legal Teams Matching Your Needs

The theme of Lawyers in Lafayette is client focus.  Our community has many people with great depths of knowledge and accomplishment.  Legal problems bypass who you are and what you have contributed to the community.  A neighbor cuts your tree.  A child gets in trouble.  A kindness in business leads to a lawsuit.  There are seemingly limitless ways that good people can be dragged into the legal system.  A large portion of our practice has been centered on protecting the right of physicians to practice medicine without corporate interference.  We are presently litigation two lawsuits against John Muir Health where we are taking them to task for putting profit before patients.  Our lead attorney, Daniel Horowitz is a (former) law school professor, a licensed Real Estate Broker, SEC registered investment advisor (RIA) and state certified Criminal Defense Specialist.  Lawyers in Lafayette  has a licensed physician, an MBA, a licensed chiropractor and talented paralegals.  We have recently welcomed physician lawyer Mark Ravis and attorney Karina Johnson (formerly working with Charles Bond at Physician’s Advocates) to Lawyers in Lafayette.  With such a diverse and deeply qualified group of attorneys and paralegals, we assemble a legal team that is very much targeted to your specific legal needs. Our model eschews the standard “Senior Partner” who brings in the case and hands it to “an associate” who bills as he/she learns – at your expense.

If criminal charges are involved both Daniel Horowitz and Dan Russo are certified by the State Bar of California, Board of Legal Specialization as criminal defense specialists.  Tom Kensok was # 2 in the Contra Costa County District Attorney’s office and also does criminal defense.

While the name “Lawyers in Lafayette” may indicate a pure Lafayette, California focus, the opposite is true.  We are proud of the fact that Daniel Horowitz is active in the Lafayette community.  He is a supporter of the Lafayette Chamber of Commerce, LPIE and he serves as a member of the City of Lafayette’s Crime Prevention Commission.  However, against that local backdrop,  Daniel’s practice has taken him throughout the world.  He has appeared in actual contested court hearings in Cyprus, Israel, Canada, and The Netherlands,  He has made legal appearances in contested legal proceedings before judicial officers in Ukraine, China and Turkey.  His U.S. cases span the United States including New York, Texas, Florida, Washington and his home state of California.  Daniel has filed briefs in the California Supreme Court, United States Supreme Court and in courts throughout the United States.

Daniel Horowitz has also been a legal commentator on the O.J. Simpson case (briefly) and extensively on the Scott Peterson and Michael Jackson cases (and many others).

Broad Expertise including Personal Injury & Business Disputes

Personal Injury, business disputes, real estate transaction issues, physician / Medical Board Defense – we have team members who have special experience in your area of need.  Business issues ?  We have an MBA.  Real Estate issues, we have a lawyer/broker.  We are here for you and we listen to your needs and do our very best to meet them.  Our lead attorney, Daniel Horowitz has over 200 jury trials as lead counsel.  He has appeared in courtrooms in Cyprus, Israel, The Netherlands and Canada.  You have also seen Daniel as a CNN and MSNBC legal commentator on the Scott Peterson and Michael Jackson trials.

Daniel’s recent cases with Dr. Alicia Kalamas and the family of Ailee Jong have resulted in front page news coverage of medical failings at John Muir Hospital.  The lawsuits seeks to reform the hospital and return it to its original purpose of being a nonprofit that serves the community.  His protection of the Stanley Vaccine Drive in Clinic resulted in complete victory for Dr. Rebecca Parish who donated her time, staff and money to provide free vaccinations to vulnerable seniors in the early days of COVID-19.

Our personal injury recoveries and verdicts are in the millions of dollars.  We have represented author Terry McMillan in her lawsuit alleging marital fraud, singer/songwriter Oksana Grigorieva against Actor Mel Gibson, Radio Show host and Podcaster, Michael Savage and many other well known local and national figures.

Medical Doctor Representation

Our medical license defense team specializes in prevention.  Physicians receiving subpoenas, initial medical board “reach-outs” are triggers for comprehensive practice audits that shore up weak points before the medical board makes a decision. If you are a doctor in trouble, we will consider forming a team with Horowitz and lawyer / medical doctor Mark Ravis who has both an M.D. (active) and J.D. (active).    Mark brings his skills and passion as an actively licensed physician to his aggressive defense of medical doctors.   Other physicians have fraud based issues and we may team with Tom Kensok who brings his years of expertise charging and prosecuting medical fraud cases, to the defense of doctors.  We are specialized and focused on your needs.  Our philosophy is one size never fits all.  We get to know you personally and design a defense that meets your needs.  Our physician practice has a separate website. (CLICK HERE)

Our Practice Model

We oppose cookie cutter practices where a major partner hires the same low level attorneys who churn out the work and run up the bills.  These practices lead to repetitive work and make the client pay to train the younger lawyer.   Our group has both in house and associated lawyers, paralegals and investigators.  We custom assemble a team that is directly suited to work on your case.  Our use of the phrase  “directly suited” means that our team members already have the expertise and experience in your area.  You do not pay for training.  We take the standard rules and laws and dive deep to find exceptions, constitutional protections and new interpretations that protect our doctors.  Daniel Horowitz will choose among people with exceptional qualifications, MBA’s,  physician-lawyers, former prosecutors, criminal defense specialists and other legal team members with specialized and exceptional qualifications.

The result of this careful team selection is that your case is expertly staffed.  There are no beginners and no trainees on your team.  Each lawyer, paralegal and investigator understands your specific issues.     We plan your case looking many steps ahead.  Law is like chess.  Planning and seeing multiple moves ahead requires years of experience.

This preparation is reflected in superior results.   Major published cases include a jury tampering victory in the 9th Circuit which resulted in freedom for the client; front page stories in the San Francisco Chronicle; SLAPP motion (successful) filed to defend a major media personality and many other published victories for his clients.

In all cases, you have Daniel Horowitz as Captain of the Ship.   Daniel’s years of experience and passion for his clients is your safety net.

Daniel Horowitz’ Extraordinary Career

Daniel’s experience is truly astounding.  Daniel has appeared in courtrooms throughout the United States and in many international jurisdictions.  CLICK HERE to read the examination conducted by Daniel Horowitz in a courtroom in Cyprus.  CLICK HERE for a cross examination conducted by Horowitz in China.  The case was dismissed shortly after.

Whatever legal issues you face, Daniel Horowitz can personally help you or (in most) refer you to an attorney who is a good match for your needs.  Daniel’s work defending physicians such as Dr. Alicia Kalamas has made the front page of the San Francisco Chronicle.  His practice focus on physician defense can be seen at his website focused on representation of physicians.

Community Service

Our group of independent attorneys are involved in our communities.  Former prosecutor Tom Kensok served Contra Costa County for over two decades.  He was in charge of training, hiring and he prosecuted high level criminal cases at the Contra Costa County District Attorney’s office.  He also defends school districts after serving for over a decade as a Napa school member.  Daniel Horowitz is a Lafayette Crime Prevention Commissioner.  Our lawyers are significant contributors to local and national charities.


Criminal Defense including standard felonies as well as specialized healthcare fraud and medical related cases

Medical License Defense including Peer Review and Medical Board defense

Personal Injury

The Medical License Defense includes physician Peer Review and Medical Board defense, chiropractic board defense, nursing board and other professional board and license matters.

Our personal injury practice includes many cases with million dollar verdicts and settlements.  We have significant trial experience in this area as well.

For Criminal Defense we have two State Bar of California Certified Specialists in criminal law. (Certified by the California Board of Legal Specialization).  Only approximately 300 lawyers in the entire state have this State Bar credential.

Feel free to call for any of your legal needs.  If we can’t help you with your problem we often can make a referral to an attorney who is highly qualified to assist you.

Contact a medical license lawyer.  Call  (925) 283-1863 or by filling out the Contact Form below.



We have recently added Karina Johnson to our team.  Karina’s practice focuses on physician contracts, divorce and medical employment matters.  Karina formerly did referral work with Charles Bond at Physicians Advocates in Walnut Creek, California.  She presently has her independent practice.

Karina Johnson attorney

 E-mail: [email protected]                                                                   Tel: 925-283-1863


We are Independent Lawyers with Separate Practices working together to provide the highest level of representation.

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