News & Analysis as of

Patient Referrals

Weber Gallagher Simpson Stapleton Fires &...

PA Supreme Court Rules Anti-Referral Provision of Workers’ Compensation Act Does Not Prohibit Physicians From Referring Their...

In a 5-2 decision issued today, the Pennsylvania Supreme Court has ruled that the placement of the phrase “goods or services ” immediately following a list of specific medical services provided in Section 306(f.1)(3)(iii) of...more

Goodwin

OIG Issues Favorable Advisory Opinions Concerning Space and Equipment Subleases and Limited Free Patient Services

Goodwin on

On May 1, 2026, the Office of Inspector General (OIG) for the US Department of Health and Human Services (HHS) posted two favorable advisory opinions, Advisory Opinion 26-08 and Advisory Opinion 26-09, offering insights into...more

Husch Blackwell LLP

False Claims Act Insights - Healthcare Compensation and Referrals: Avoiding Compliance Pitfalls in Physician Deals

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Host Jonathan Porter welcomes Husch Blackwell’s Hal Katz back to the podcast to discuss best practices for structuring physician compensation arrangements and navigating the complex compliance landscape surrounding healthcare...more

Wilson Sonsini Goodrich & Rosati

But "We Don't Take Insurance": Why Cash-Pay Digital Health Companies Still Face Kickback and Fee-Splitting Risk

Cash-pay healthcare companies enjoy many regulatory freedoms that their insurance-accepting counterparts do not. However, cash-pay healthcare companies, their founders, operators, and investors, and the providers they work...more

Rivkin Radler LLP

OIG: Offering Bonuses to Employees for Referrals Implicates AKS and CMP

Rivkin Radler LLP on

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services recently issued an unfavorable Advisory Opinion (No. 25‑12) addressing a home health care agency’s proposal to offer sign‑on bonuses to...more

Mintz - Health Care Viewpoints

The Eliminating Kickbacks in Recovery Act in 2025: New Developments and New Questions for Laboratory Sales Compensation —...

Eliminating Kickbacks in Recovery Act (EKRA) enforcement remains uncertain for clinical laboratories, even after the Ninth Circuit’s Schena decision and New Jersey’s recent patient brokering amendments. This update covers...more

Husch Blackwell LLP

Hospice Insights Podcast - Hospital to Hospice: Managing Referrals and Relationships

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A common referral scenario involves hospital clinicians referring a dying patient to hospice. This circumstance gives rise to questions relating to hospice eligibility, the appropriate level of hospice care, and the...more

Benesch

Dental/DSO Intelligence Monthly Report: November 2025

Benesch on

DSOs and dental providers are embedding medical care into dental settings while navigating new state-level insurance reforms. U.S. DSOs and multi location dental providers are increasingly experimenting with models that...more

McDermott Will & Schulte

New Jersey expands patient brokering statute to include laboratories, recovery homes

McDermott Will & Schulte on

On August 11, 2025, New Jersey Lieutenant Governor Tahesha Way, acting for Governor Phil Murphy, signed into law two bills, A3973/S3952 and A3974/S3955 (collectively, the 2025 amendment), that modify New Jersey’s existing...more

Health Care Compliance Association (HCCA)

[Virtual Event] Physician Practice Compliance Conference - October 28th, 8:00 am - 5:00 pm CT

Are you in a physician practice and looking for updates on compliance trends and initiatives? Join us this October for HCCA’s virtual Physician Practice Compliance Conference and get insights, updates, and strategies for...more

McGuireWoods LLP

Marketing, Misconduct and Healthcare: Ninth Circuit Issues First EKRA Appellate Ruling

McGuireWoods LLP on

On July 11, 2025, in United States v. Schena, the U.S. Court of Appeals for the Ninth Circuit issued the first appellate decision interpreting the Eliminating Kickbacks in Recovery Act (“EKRA”). The decision marks a...more

BakerHostetler

Alive and (Anti)Kicking: EKRA Prosecutions on the Rise in California with Multiple Recent Indictments

BakerHostetler on

In the past few months, federal prosecutors in California have brought multiple indictments under the Eliminating Kickbacks in Recovery Act (EKRA) charging the owners of substance abuse treatment facilities and their...more

Pietragallo Gordon Alfano Bosick & Raspanti,...

New Jersey Enacts Key Legislation Addressing Kickbacks and Deceptive Marketing Practices in the Substance Use Disorder Treatment...

On August 11, 2025, New Jersey’s Acting Governor, Tahesha Way, signed into law two bills to combat patient brokering and deceptive marketing practices in the Substance Use Disorder (“SUD”) treatment industry. The legislation,...more

Morgan Lewis - Health Law Scan

Ninth Circuit Ruling Confirms Strength of the Eliminating Kickbacks in Recovery Act

Since its enactment in 2018, the Eliminating Kickbacks in Recovery Act (EKRA) has rapidly gained momentum as a powerful tool against healthcare kickbacks. By 2020, the US Department of Justice (DOJ) had already secured its...more

Venable LLP

EKRA Has Teeth: Ninth Circuit Upholds Lab Operator’s Criminal Conviction for Paying Marketers for Referrals

Venable LLP on

In a matter of first impression, the Ninth Circuit Court of Appeals interpreted the scope of the 2018 Eliminating Kickbacks in Recovery Act (EKRA) in the context of a lab operator who allegedly paid marketers to induce...more

King & Spalding

OIG Issues Favorable Advisory Opinion Permitting a Community Health Center to Refer Primary Care Services During Provision of...

King & Spalding on

On April 9, 2025, OIG posted Advisory Opinion No. 25-02, a favorable advisory opinion allowing a community health center operating under Section 330 of the Public Health Service Act (the Requestor) to ask individuals, to whom...more

Morrison & Foerster LLP

True Facts About False Claims: MoFo's FCA Newsletter - January 2025

Designed for busy in-house counsel and compliance professionals, this newsletter seeks to bring you up to speed on key federal and state False Claims Act (FCA) developments, with links to primary resources. Each quarter, we...more

Hendershot Cowart P.C.

Texas Healthcare Providers Paid $21.3 Million to Resolve Stark Law Violations in 2024

Hendershot Cowart P.C. on

Healthcare fraud enforcement continues to be a top priority for federal authorities, with Stark Law violations remaining under particular scrutiny. The complex nature of physician self-referral regulations, combined with...more

Stevens & Lee

Special Fraud Alert: Suspect Payments in Marketing Arrangements Related to Medicare Advantage and Providers

Stevens & Lee on

On Dec. 11, 2024, the OIG issued a Special Fraud Alert (Alert) related to certain fraud and abuse risks associated with marketing arrangements between Medicare Advantage Organizations (MAOs) and health care professionals...more

Quarles & Brady LLP

Legal Marketing Tactics or an Illegal Kickback Scheme? The Seventh Circuit’s Impending Decision on the Expansiveness of the...

Quarles & Brady LLP on

On December 4, the U.S. Court of Appeals for the Seventh Circuit heard oral arguments in USA v. Mark Sorensen, case number 24-1557, and it is now taking under advisement a case that could have widespread effects as to what...more

Haight Brown & Bonesteel LLP

Evidence of the Reasonable Value of Medical Services for Non-Emergency Care Provided by a Hospital is governed by the Howell...

In David Yaffee v. Joseph Skeen, et al., (Filed 11/25/2024, C097746 and C097988), the California Court of Appeal, Third Appellate District, held that evidence of the reasonable value of medical services rendered to an insured...more

McDonald Hopkins

Preparing For 2025 Stark Enforcement Regarding Compensation and Productivity Bonuses

McDonald Hopkins on

In 2024, Stark enforcement remains a critical focus for healthcare providers and regulatory bodies, with a continued focus on excessive compensation and productivity bonuses. Compliance with Stark Law is essential to avoid...more

Cozen O'Connor

Multistate Coalition Settles False Claims Allegations with Precision Diagnostics

Cozen O'Connor on

A multistate coalition of 44 AGs and the U.S. Department of Justice settled with Precision Toxicology, LLC d/b/a Precision Diagnostics, Inc. (Precision) to resolve allegations that it made false claims to multiple federal...more

Maynard Nexsen

Insights from a Recent Court Decision

Maynard Nexsen on

The Eliminating Kickbacks in Recovery Act (EKRA), 18 U.S.C. § 220, is a criminal statute that prohibits knowingly and willfully soliciting or receiving remuneration for referring patients to recovery homes, clinical treatment...more

Rivkin Radler LLP

Radiology Practice to Pay $8.9M to Resolve FCA/AKS Claims

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The U.S. Attorney’s Office for the Southern District of Texas announced on August 20 that National Interventional Radiology Partners PLLC (NIRP) and its founder and CEO will pay $8,884,091 to the United States to resolve...more

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