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The health industry has always been complicated and filled with issues. The US federal government has been proactive in establishing laws to improve health services and abduct frauds, corruption, and other crimes relating to healthcare.
For years, the country has been facing healthcare and services-related problems that have led to epidemics. With the sudden rise of the worldwide pandemic, the government is challenged to keep the health industry function efficiently and effectively.
Unfortunately, the added stress caused by the pandemic also risks the rise of health-related cases. Thankfully, there are laws to stop issues when it comes to these.
Certain health issues that are common nowadays are drug abuse and fraud. The government has written new laws to counter these threats like EKRA.
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 the 24th day of October last 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.
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)Click To TweetThere are people who 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 of referrals to a clinics, laboratories, recovery centers, and such
- Giving out any kind of payments to clinics, laboratories, recovery centers, and such-
- to be able to gain referrals in any way, or
- to use any sort of services 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 forms 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. There are eleven statutory and twenty-eight regulatory safe harbors that are overlapping 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 payments 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 EKRA law has been passed, there are several violators caught and charged already. Just in this year, there are several reports of individuals and entities who are found guilty of not complying under EKRA.
In the first quarter of 2020, the first conviction under EKRA was against a woman who pleaded guilty to soliciting kickbacks in exchange for referrals from a laboratory. In New Jersey, a man was charged with violating EKRA because of allegedly referring insurance beneficiaries to a COVID-19 testing provider.
The peak of the COVID-19 pandemic has also increased healthcare services-related fraud. The Department of Justice (DOJ) worries that the pandemic will ignite violations from laboratories and clinics. They have expressed and shared that the department will be looking into cases more aggressively in the next year because of the recent events. They also ensure that institutions and individuals are following EKRA and AKS regulations.
The Eliminating Kickback in Recovery Act was included in the SUPPORT Act to not only eliminate opioid drug abuse but also to prevent others from profiting from them. This law was initiated because of the opioid epidemic but is now also fighting against fraud that have emerged from the COVID-19 pandemic.
The EKRA was written much more clearly and was created to have a wider effect on the country’s health industry. The law has affected not only public institutions. It also limits private establishments. Since the EKRA was approved by Congress, companies have adjusted their relationship with employees and partnered personnel. They have been careful to follow not only the Anti-Kickback Statutes but also to comply with EKRA as well.
