In return, the chiropractic doctor agrees to refer patients to the vitamin company, or agrees to provide an e-commerce location on the chiropractor's website where patients can purchase vitamins by credit card. If a patient does purchase the vitamins on the website, the vitamin company or internet company, not the doctor, charges the patient's credit card. If there is an internet company involved, they also keep a percentage of the sale and may even charge the vitamin company a fee for selling their product on the doctor's website. In general terms, the federal anti-kickback law prohibits a doctor from having a financial relationship with anyone with whom the doctor has a referral relationship, unless the referral falls with an enumerated exception. Vitamins, since they are not a MediCare program-related item or service, are not reached by this law.
Most states have similar anti-referral statutes.
Not only are all goods and services typically included within these state statutes, but these statutes also extend not only to patients, but to clients and customers. This distinction is very significant for two reasons. This distinction is almost always irrelevant under state law. In addition, these state laws are usually not restricted to just 11 categories of health care products and services. In both scenarios, the doctors are receiving money for sending customers to e-commerce vendors.