What You Need to Know About EKRA and Private Insurance Fraud Charges

By Barry Wax

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News

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Sep 18, 2025

If you work in healthcare, especially in addiction treatment, labs, or recovery homes, you’ve likely heard about EKRA. But many people don’t realize how serious it is until they’re already under investigation. EKRA, short for the Eliminating Kickbacks in Recovery Act, is a federal law that makes it a crime to receive or pay kickbacks for patient referrals, even when those referrals are tied to private insurance.

In other words, it’s like Medicare fraud laws but for private payers. And federal prosecutors are taking it seriously.

Why EKRA Exists

EKRA was passed in 2018 as part of a broader law aimed at curbing opioid abuse and addiction treatment fraud. Before EKRA, most anti-kickback laws primarily focused on government healthcare programs, such as Medicare and Medicaid. But that left a gap. Providers could avoid those laws by targeting patients with private insurance instead.

EKRA closed that gap. Now, offering or accepting money or anything of value for referring patients to certain healthcare facilities is illegal, regardless of whether the insurance is public or private.

Who Is at Risk

EKRA mainly targets kickbacks in addiction treatment, clinical labs, and recovery homes. But that’s not the only place it applies. If your business involves referring patients, receiving referrals, or paying third parties based on the number of patients they refer, you should be paying attention.

Common targets include:

• Addiction treatment centers
• Drug testing labs
• Sober living facilities
• Marketers who get paid per lead or per test
• Business owners who pay staff based on the number of referrals or admissions

If you’re in this space and part of your business model includes commissions, bonuses, or referral fees tied to patient volume, EKRA may apply.

How EKRA Differs from the Anti-Kickback Statute

The federal Anti-Kickback Statute (AKS) applies to government programs. EKRA applies more broadly and doesn’t stop at federal insurance. It includes private payers, which means it can be used in more cases.

Another big difference: EKRA has fewer exceptions. While the AKS allows for certain safe harbor arrangements, EKRA does not include the same protections. That means a marketing agreement that’s legal under the AKS might still violate EKRA.

This lack of clarity has made it harder for providers and business owners to know where the line is and easier for prosecutors to bring charges.

The Penalties Are Severe

A violation of EKRA can result in up to 10 years in prison and a fine of up to $200,000 per offense. And if there are multiple referrals, each one can be treated as a separate offense.

That means a single business relationship, or even one month of referrals, can result in several felony counts. Even if the conduct seems minor or even the industry standard, the government may see it as criminal behavior under EKRA.

What to Do If You Think You’re at Risk

If you’ve been contacted by federal investigators or received a subpoena related to EKRA, do not try to explain or fix the situation yourself. Anything you say could be used to build a case against you.

Here’s what you should do:

• Stop any conduct that might be seen as a kickback immediately
• Preserve all documents and communication related to referrals and payments
• Get a defense attorney who understands how EKRA prosecutions work

You also don’t need to wait until you’re charged. If you suspect your business model may be vulnerable, now is the time to assess the risk and address it before it escalates into a criminal case.

This Isn’t Just About Business. It’s Personal

When you’re in this position, it’s not just your business on the line. It’s your license, your reputation, your family, and your freedom. You need someone who won’t just defend you in court, but who will understand what’s at stake in your life.

Barry Wax gives people in trouble the ability to make the right choices and regain control of their lives. If you’ve been contacted about an EKRA violation or are concerned about your business’s exposure, call Barry.