Eliminating Kickbacks in Recovery Act of 2018

To amend title 18, United States Code, to establish criminal penalties for unlawful payments for referrals to recovery homes, clinical treatment facilities, and laboratories. 1. Short title This Act may be cited as the Eliminating Kickbacks in Recovery Act of 2018 2. Criminal penalties (a) In general Chapter 11 section 219 220. Illegal remunerations for referrals to recovery homes, clinical treatment facilities, and laboratories (a) Offense Except as provided in subsection (b), whoever, with respect to services covered by a health care benefit program, in or affecting interstate or foreign commerce, knowingly and willfully— (1) solicits or receives any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in-kind, in return for referring a patient or patronage to a recovery home, clinical treatment facility, or laboratory; or (2) pays or offers any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in-kind— (A) to induce a referral of an individual to a recovery home, clinical treatment facility, or laboratory; or (B) in exchange for an individual using the services of that recovery home, clinical treatment facility, or laboratory, shall be fined not more than $200,000, imprisoned not more than 10 years, or both, for each occurrence. (b) Applicability Subsection (a) shall not apply to— (1) a discount or other reduction in price obtained by a provider of services or other entity under a health care benefit program if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider or entity; (2) a payment made by an employer to an employee or independent contract (who has a bona fide employment or contractual relationship with such employer) for employment, if the employee’s payment is not determined by or does not vary by— (A) the number of individuals referred to a particular recovery home, clinical treatment facility, or laboratory; (B) the number of tests or procedures performed; or (C) the amount billed to or received from, in part or in whole, the health care benefit program from the individuals referred to a particular recovery home, clinical treatment facility, or laboratory; (3) a discount in the price of an applicable drug of a manufacturer that is furnished to an applicable beneficiary under the Medicare coverage gap discount program under section 1860D–14A(g) of the Social Security Act (42 U.S.C. 1395w–114a(g)); (4) a payment made by a principal to an agent as compensation for the services of the agent under a personal services and management contract that meets the requirements of section 1001.952(d) of title 42, Code of Federal Regulations, as in effect on the date of enactment of this section; (5) a waiver or discount (as defined in section 1001.952(h)(5) of title 42, Code of Federal Regulations, or any successor regulation) of any coinsurance or copayment by a health care benefit program if— (A) the waiver or discount is not routinely provided; and (B) the waiver or discount is provided in good faith; (6) a remuneration described in section 1128B(b)(3)(I) of the Social Security Act (42 U.S.C. 1320a–7b(b)(3)(I)); (7) a remuneration made pursuant to an alternative payment model (as defined in section 1833(z)(3)(C) of the Social Security Act) or pursuant to a payment arrangement used by a State, health insurance issuer, or group health plan if the Secretary of Health and Human Services has determined that such arrangement is necessary for care coordination or value-based care; or (8) any other payment, remuneration, discount, or reduction as determined by the Attorney General, in consultation with the Secretary of Health and Human Services, by regulation. (c) Rule of construction Neither actual knowledge of this section nor specific intent to commit a violation of this section shall be an element of an offense under this section. (d) Regulations The Attorney General, in consultation with the Secretary of Health and Human Services, may promulgate regulations to clarify the exceptions described in subsection (b). (e) Definitions In this section— (1) the terms applicable beneficiary applicable drug (2) the term clinical treatment facility (3) the term health care benefit program (4) the term laboratory 42 U.S.C. 263a (5) the term recovery home . (b) Clerical amendment The table of sections for chapter 11 220. Illegal remunerations for referrals to recovery homes, clinical treatment facilities, and laboratories. .

Summary: Eliminating Kickbacks in Recovery Act of 2018 This bill amends the federal criminal code make it a crime to knowingly and willfully solicit, receive, pay, or offer payment for referrals to a recovery home, clinical treatment facility, or laboratory, subject to limitations. A violator is subject to criminal penalties—a fine, a prison term of up to 10 years, or both.