Healthcare providers in Metro Atlanta are finding that referral arrangements now face intense federal review. Toxicology labs, telemedicine companies and recovery facilities are common targets. These cases usually involve referral fees or payments tied to patients.
What federal law actually prohibits
Most referral fee cases in Georgia involve one or more of these federal laws:
- Eliminating Kickbacks in Recovery Act (EKRA): Prohibits paying or receiving anything of value for patient referrals to clinical labs, recovery homes and treatment centers
- Anti-Kickback Statute (AKS): Prohibits referral-related payments tied to any federal healthcare program
- False Claims Act: Prohibits submitting false or fraudulent claims to Medicare or Medicaid
The Georgia False Medicaid Claims Act matches the federal False Claims Act. Georgia also bars fee-splitting among healthcare providers. One referral arrangement can trigger both federal and state charges.
How legitimate payments get flagged
How a payment is structured is often what draws federal attention. Common setups that trigger federal investigations include:
- A marketing representative paid per patient referral
- A lab that pays a consultant based on the number of test orders
- A treatment center that rewards staff based on patient intake numbers
These arrangements do not automatically break the law. However, they can raise concerns when payments link to referrals or patient volume. Providers should review how they calculate compensation and whether it looks like an incentive for referrals.
The role of criminal intent
Federal healthcare fraud cases require proof of criminal intent. The government must show that violations occurred “knowingly and willfully.” This means prosecutors do not need to prove the defendant knew about the Anti-Kickback Statute. They only need to show the defendant knew the conduct was wrong. The facts of each case surrounding the conduct can help determine whether criminal intent existed.
How safe harbors offer legal protection
Both EKRA and AKS include safe harbors. These are legal exceptions that protect certain payment structures from charges. AKS safe harbors cover bona fide employment and personal services contracts. EKRA protects employees and contractors paid fixed amounts. Those fixed amounts must not be tied to referral volume, test counts or billing totals. Meeting safe harbor requirements can reduce the risk of violating federal law.
Protecting your medical practice
Knowing whether your arrangements comply with federal law is important. In such cases, legal counsel can assess whether arrangements meet safe harbor requirements and identify compliance issues. If you have concerns about your practice, consider speaking with a healthcare attorney before the issue becomes a larger legal problem.