Anti-kickback statute
The federal anti-kickback statute (AKS) makes it a crime to knowingly offer or receive anything of value to induce referrals of business payable by federal healthcare programs — with safe harbors protecting defined arrangements that fit them exactly.
- Federal criminal statute; intent-based and broad
- Reaches any remuneration inducing federal-program referrals
- Safe harbors protect arrangements that meet every element
- State all-payor kickback laws reach cash-pay too
What the statute reaches
The AKS is intent-based and broad: any remuneration — money, discounts, free services, above-market compensation — exchanged to induce referrals of Medicare, Medicaid, or other federal-program business can violate it, and one purpose being inducement is enough. Regulatory safe harbors protect specific structures (properly structured employment, space and equipment leases, personal-services arrangements at fair market value) but only when every element is met.
The cash-pay caveat that isn’t a free pass
Pure cash-pay programs sit largely outside the federal AKS because no federal program pays. Two cautions keep it relevant anyway: many states have their own kickback and inducement laws that reach all payors — cash included — and programs rarely stay pure cash-pay forever. A model that would violate the AKS the day insurance arrives (per-referral marketing payments, volume-based clinician bonuses) is a model built on a landmine; compliant programs structure compensation as if the AKS applied from day one.
Compliance handled, so you can build
Lithos runs the clinicians, pharmacies, and 50-state rules behind your care program — one API.
Frequently asked questions
Does the AKS apply to cash-pay telehealth?
The federal statute generally does not reach purely cash-pay business — but state kickback laws often do, and adding insurance later brings the AKS in fully. Structure as if it applies.
What arrangements draw AKS scrutiny in digital health?
Per-patient marketing payments, volume-tied clinician compensation, and discounts or free services exchanged between referral partners are the recurring patterns in enforcement.
What is a safe harbor?
A regulatory template — like fair-market-value personal services — that immunizes an arrangement if every element is satisfied. Close only counts as exposure.