Missouri Anti-Kickback & Referral Laws

Missouri Anti-Kickback Law at a Glance

Missouri’s anti-kickback and referral laws are designed to prevent improper financial incentives that may influence health care decisions. These laws impose restrictions on fee-splitting and referral arrangements, particularly in the context of health care services. While Missouri does not have a specific statute that mirrors the federal Stark Law, its statutes do impose criminal and civil liability for kickbacks or bribes related to health care referrals, aligning with broader federal and state regulatory frameworks. These laws are enforced through both criminal prosecution and civil remedies, and they apply to a range of health care providers, including physicians, hospitals, and other entities involved in the referral process.

State Statutes

Mo. Rev. Stat. § 191.905(2) criminalizes the offering, paying, soliciting, or receiving of kickbacks or bribes for the purpose of inducing or rewarding referrals of items or services payable by a health care program. This provision applies broadly to any individual or entity involved in health care referrals, regardless of whether the referral is connected to a federal health care program. The statute is enforced by both criminal and civil mechanisms, which may result in fines, penalties, or other legal consequences.

Mo. Rev. Stat. § 191.905(3) extends this liability to any individual or entity that knowingly and willfully engages in such conduct. This provision reinforces the state’s commitment to preventing corruption in health care referrals by imposing strict liability on those who knowingly participate in unlawful kickback schemes. These statutes work in tandem with federal anti-kickback laws, creating a layered legal framework that governs health care referral practices in Missouri.

Enforcement

Enforcement of Missouri’s anti-kickback and referral laws is primarily handled by state licensing boards and regulatory agencies, including the Missouri Board of Registration for the Healing Arts, the Missouri Board of Nursing, and the Missouri Department of Health and Senior Services. These entities are responsible for investigating potential violations, imposing disciplinary actions, and ensuring compliance with applicable laws. In addition, criminal enforcement may be pursued by the Missouri Attorney General’s Office or local prosecutors in cases involving intentional misconduct.

The Federal Overlay

The federal Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b), makes it a felony to knowingly and willfully offer, pay, solicit, or receive remuneration to induce or reward referrals of items or services payable by a federal health care program. The Stark Law, 42 U.S.C. § 1395nn, separately prohibits physician self-referrals for designated health services payable by Medicare or Medicaid, on strict-liability terms. Both regimes carry safe harbors and exceptions published at 42 C.F.R. § 1001.952. State referral and fee-splitting statutes operate alongside these federal prohibitions and can apply even where no federal program payment is involved.

Reading the State Desk

Missouri’s anti-kickback and referral laws interact with federal regimes in complex ways. For further analysis on these interactions, see /practice-areas/ for an overview of research topics, /the-anti-kickback-statute-explained-why-referral-payments-trigger-scrutiny/ for a detailed explanation of the Anti-Kickback Statute, /safe-harbors-under-the-anti-kickback-statute-and-where-providers-get-tripped-up/ for an analysis of safe harbors, /aks-and-stark-law-how-the-two-regimes-overlap-in-healthcare-investigations/ for an exploration of AKS and Stark Law overlap, /recent-antikickback-statute-decisions/ for recent developments, and /faq/ for frequently asked questions.