Understanding EKRA Law: Your Essential Guide

The healthcare industry in the U.S. has always been a complex arena, beset with various challenges. To address these issues, the federal government has been proactive in creating laws aimed at enhancing health services and tackling fraud, corruption, and other related crimes.

The country has long faced significant issues in healthcare and service delivery, challenging the government’s ability to ensure efficient and effective healthcare management.

Unfortunately, increased stress factors in recent times have heightened the risk of health-related cases. However, there are robust legal frameworks in place to mitigate these concerns.

Prominent health issues today include drug abuse and fraud. To combat these, the government has introduced new legislation, such as the Eliminating Kickbacks in Recovery Act (EKRA), to counteract these threats effectively.

What is EKRA?

EKRA is the abbreviation of the Eliminating Kickbacks in Recovery Act. It is included in the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). Both were passed by Congress on October 24, 2018. 

The SUPPORT Act was created to fight the opioid epidemic – the severe abuse of misusing drugs like Vicodin. As part of this initiative, Congress included EKRA to prevent further substance abuse caused by greedy patient brokers. 

Some people make a career by using other people’s weaknesses. Patient brokers refer patients to the best companies with the highest biddings. Aside from the kickbacks, they will get from companies, some brokers would even con patients into giving them money to gain more. 

With EKRA, brokers are inhibited from profiting by referring patients to laboratories, drug recovery clinics, and treatment centers in exchange for kickbacks. This also protects patients from fraud.   

What Are Considered Illegal Under EKRA? 

With EKRA being an active law for years now, it has affected the way clinics, laboratories, and other related establishments manage themselves. Healthcare providers are more careful in handling their patients. They follow the EKRA law guide to avoid committing any violations and charges against them. 

As stated in the law, the following actions are deemed illegal under the Eliminating Kickbacks in Recovery Act:

• Accepting any type of commission in any way and form in exchange for referrals to clinics, laboratories, recovery centers, and such
• Giving out any payments to clinics, laboratories, recovery centers, and such-
  • to be able to gain referrals in any way, or
  • to use any sort of service in return

Whoever is found doing these will be sanctioned to pay a $200,000 fine or imprisoned for up to 20 years. Both sanctions can be given out at the same time. Also, these disciplinary actions are given per occurrence.

EKRA in a Wider Perspective 

You might have heard EKRA being compared or linked to the federal Anti-Kickback Statute. Sure, both have similarities, but the Eliminating Kickbacks in Recovery Act covers more areas than the Anti-Kickback Statute (AKS) and other federal statutes. 

AKS is only focused on federal and state health centers. On the other hand, EKRA is not limited to public institutions but broadly covers private institutions as well. 

Both EKRA and AKS are against any form of payment for referrals. However, there are still exemptions that are stated in safe harbors. The other difference between these two laws is that EKRA has fewer exemptions compared to AKS. Eleven statutory and twenty-eight regulatory safe harbors overlap with one another under the AKS while EKRA only has seven.

The only exemptions allowed on EKRA are the following: 

• When discounts on prices are properly stated
• Certain payments to employees (as long as it do not vary based on referrals) 
• Part D drug discounts 
• Any personal services payments complying with the exemptions under the AKS
• Copay waivers (not routinely provided)
• Subsidies given to federally certified health clinics 
• Approved alternative payment models

These are conditions that do not go against or are deemed legal under the Eliminating Kickbacks in Recovery Act.

Since EKRA covers a wide field. It is possible that breaking this law will result in violating other laws as well. Federal statutes such as the AKS or the False Claim Act may be breached. 

Aside from these, the penalties against these two statutes are different. The EKRA violators can possibly have higher penalties compared to those who violate AKS. 

Recent Updates About The EKRA Law 

Since the enactment of the Eliminating Kickbacks in Recovery Act (EKRA), there have been numerous cases of violators being caught and charged. In this year alone, multiple reports have surfaced of individuals and entities found guilty of non-compliance under EKRA.

In early 2020, the first EKRA conviction involved a woman pleading guilty to soliciting kickbacks in exchange for laboratory referrals. In New Jersey, a man faced charges for allegedly referring insurance beneficiaries to a testing provider in violation of EKRA.

The Department of Justice (DOJ) is increasingly concerned about healthcare service-related fraud, especially in the current climate. The DOJ has announced plans to intensify investigations in the coming year, ensuring adherence to both EKRA and Anti-Kickback Statute (AKS) regulations.

EKRA, part of the SUPPORT Act, was initially aimed at combating opioid drug abuse and preventing profit from it. However, its scope has expanded to address various forms of healthcare fraud.

EKRA’s clear wording and broad impact significantly affect the country’s health industry, encompassing both public and private institutions. Since its approval by Congress, companies have been diligently adjusting their relationships with employees and partners, ensuring compliance not only with the Anti-Kickback Statutes but with EKRA as well.