Welcome EKRA to the Pantheon of Healthcare Fraud Laws

Healthcare Compliance Officers with oversight responsibilities that include a reference laboratory, SUD treatment facility, recovery home or related entity have something new to add to their 2019 compliance plans. EKRA, the Eliminating Kickbacks in Recovery Act of 2018 (Section 8122 of the SUPPORT Act) went into effect as of October 24, 2018.  EKRA is an all-payor anti-kickback law intended to address improper payments for patient referrals to recovery homes, clinical treatment centers, or clinical laboratories.  According to the National Law Review, “broad language enables the federal government to monitor provider arrangements intended to generate business for any laboratory services, not only those related to individuals in treatment for substance abuse disorders, payable by a federal health care program (“FHCP”) or commercial health insurer.”

Outrage often breeds legislation. The recent high-profile fraud and abuse cases involving questionable services at sober homes and the ‘great gold rush’ of laboratories capitalizing on demand for urine toxicology screening set the stage for EKRA.