New Georgia Law Bans Patient Brokerage For Addiction Providers | McGuireWoods LLP

July 1, 2021, Georgia’s new anti-kickback law Related to drug addiction, patient brokering began to prohibit payment, or the offer of compensation, to induce referral of a patient to or from an addiction provider. The Georgian legislature passed the law after lawmakers identified a model of drug treatment centers seeking patient referrals from providers in exchange for a fee. Under Georgia’s new statute, such payment or offers of payment in exchange for referrals of patients to government or commercial insurance may result in criminal liability, including possible imprisonment.

Georgian law also draws on a growing number of state and federal laws relating to drug addiction and patient brokering, such as the Federal Act on the Elimination of Bribes in Recovery (EKRA), 2018, which prohibits soliciting or receiving remuneration in exchange for referrals related to drug treatment services. . Entities and individuals operating in the healthcare space in Georgia and elsewhere, including drug treatment centers and healthcare professionals, must remain vigilant and avoid breaking Georgian law or others. applicable state and federal laws relating to patient brokering. These entities and individuals must also ensure that safeguards are in place to prevent prohibited referrals and ensure that any referrals comply with the exceptions permitted by applicable laws.

Context of the Statute of Georgia

Prior to the enactment of the law, Georgia prohibited inappropriate patient referrals under the Title 43 Patient Self-Referral Act, which remains a broader ban on kickbacks for patient referrals for any type of patient. supplier approved under Title 43 (e.g. doctors, pharmacists). As mentioned above, the new law prohibits anyone from soliciting, receiving, paying or offering to pay compensation to induce patients to be referred to or from drug addiction service providers.

The new Georgian law states that compensation includes, “but is not limited to, a commission, benefit, bonus, discount, bribe or bribe, directly or indirectly, in cash or in kind, or a cost sharing arrangement, in any form. . “An addiction provider includes any” state-owned or operated hospital, community mental health center, or other facility used for the diagnosis, care, treatment or hospitalization of persons with alcoholism, drug abuse drug addicts, and any other hospital or facility in the State of Georgia approved for these purposes by the Department of Behavioral Health and Developmental Disorders. Notably, Georgian law applies to both public and private payers. The law contains exceptions, including provisions that are not prohibited under the Federal Anti-Recoil Act (AKS) and its associated safe zones.

Georgian law also imposes criminal penalties for excessive and fraudulent medical tests related to the treatment of the elderly, the disabled or those suffering from pain, drug addiction, drug addiction or any other disorder.

Penalties for violating any part of Georgian law include both fines and jail time, depending on the number of patients involved. Conduct in violation of the law involving fewer than 10 patients could result in a misdemeanor punishable by jail time of up to 12 months and a fine of up to $ 1,000 per violation.

App and takeaway

The practical implications of Georgian law may not be important for most Georgian addiction service providers due to the EKRA. The EKRA imposes similar prohibitions to Georgian law, but at the federal level. EKRA applies to drug treatment services paid for by all payers, including private commercial health care insurers as well as federal and state health care programs. It prohibits the solicitation, reception, payment or offer of any remuneration, directly or indirectly, in cash or in kind, in return for referral to a recovery house, clinical treatment center or laboratory. EKRA also prohibits the payment or collection of remuneration in exchange for an individual using the services of a recovery house, clinical treatment center or laboratory.

Increasingly, states are also creating laws to regulate drug treatment and enforce penalties against those who may inappropriately procure patients in their own state. Florida passed its anti-kickback law in 2016. California, New York, Tennessee, Utah, and other states have passed similar laws. Here is a list of highlights related to Georgia’s status:

  1. Ensure compliance. Healthcare provider entities and individuals operating in Georgia should consider whether Georgian law affects their operations and ensure that they do not receive or pay remuneration for referrals unless they comply with legal exceptions. . All healthcare providers should be made aware of EKRA and any other applicable state law relating to patient brokering and drug addiction, as the potential criminal liability for bribes associated with such arrangements continues to expand.
  2. Maintain guarantees and documentation. Healthcare providers should ensure that policies and procedures are in place to comply with applicable laws, and appropriate training for individual providers and staff may be required to implement compliance standards. For all guidance arrangements made in relation to an allowable exception, a healthcare provider must ensure that these arrangements are properly documented to align with each element of applicable law.
  3. Expect additional regulation. Especially with the growing focus on substance abuse, mental health and the provision of health services to people living with such conditions, health care providers should expect more attention to the laws applicable to these conditions. services. At the federal level, EKRA is regulated by the Attorney General, not the Department of Health and Human Services, and therefore, it is not clear how the existing AKS Safe Zones will apply to EKRA. States may have similar ambiguities with existing laws. As evidenced by the growing number of states enacting similar laws, the regulation of drug treatment services and the government’s scrutiny of arrangements related to these services are likely to increase and must be viewed in light of other drug treatment laws. States.

As states enact laws in this space and the extent of EKRA’s implications remains uncertain, healthcare providers and individuals operating in Georgia and elsewhere must remain vigilant to understand their application. Please contact the authors for more information regarding the status of Georgia and the EKRA and their application to certain provisions according to the current understanding of the law.

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