In 2018, the U.S. Congress passed a law called the Eliminating Kickbacks in Recovery Act (EKRA) to stop unethical practices around patient referrals in addiction recovery. Essentially, EKRA makes it illegal to offer or accept bribes or “kickbacks” for referring patients to recovery homes, treatment facilities, or labs. This law helps combat fraud, particularly in opioid addiction recovery efforts.

Main Points of EKRA:

1. Targeting Unethical Practices: EKRA focuses on “patient brokers” — people who refer patients to recovery services in exchange for illegal payments. These brokers might also trick patients by enrolling them in unnecessary, expensive treatments to get bigger insurance payouts.

2. Covers Various Services: Unlike other laws that only cover services paid by government programs, EKRA applies to all referrals, regardless of whether they are covered by public or private insurance, or even if the patient pays out of pocket.

3. What EKRA Prohibits: It’s illegal under EKRA to:

• Solicit or receive any payment for referring patients to specific recovery services.

• Offer or pay any bribe to someone to refer patients to use these services.

4. Broad Application: EKRA affects all clinical settings, from small recovery homes to big laboratories. Even hospitals that only test their own patients fall under this law.

5. Severe Penalties: Violating EKRA can result in fines up to $200,000 and up to 10 years in prison for each offense.

EKRA vs. Other Anti-Kickback Laws:

EKRA is similar to older anti-kickback laws but has some unique features:

• It includes services paid privately, not just by government health programs.

• It allows fewer exceptions than other laws. For example, it’s stricter about how employees can be paid in healthcare settings.

• It sets tougher penalties for breaking the law.

First EKRA Conviction:

In 2020, a manager at a Kentucky addiction treatment clinic was convicted under EKRA for accepting bribes from a lab. This case highlights how seriously these laws are enforced.

Recent Court Cases:

Courts have differed on whether EKRA applies to marketers of recovery services. For example, a Hawaii court said no, but a California court disagreed, emphasizing that paying marketers to recruit patients is illegal.

Link to False Claims Act:

Like other anti-fraud laws, EKRA violations can lead to more charges under the False Claims Act. This happens when a healthcare provider falsely claims they’ve complied with laws like EKRA while billing government health programs.

The Takeaway:

EKRA is a powerful tool for cracking down on fraud in addiction recovery services. It promises to protect patients and ensure that recovery efforts are ethical and legal. We’ll keep an eye on how this law evolves and its impact on reducing fraud in healthcare