New Mexico Anti-Kickback & Referral Laws

New Mexico Anti-Kickback Law at a Glance

New Mexico's anti-kickback and referral laws focus primarily on preventing improper financial incentives in the referral of patients for healthcare services. The state's approach is shaped by its statutes governing the discipline of licensed professionals who engage in fee-splitting or receive consideration for referring patients. These rules are particularly relevant in healthcare settings, where arrangements between providers and third parties must be carefully structured to avoid violations. While New Mexico does not have a broad statutory prohibition on fee-splitting, it does impose discipline for licensed individuals who receive consideration for referrals, aligning with broader federal anti-kickback and Stark Law principles.

State Statutes

N.M. Stat. § 61-6-15 governs the discipline of licensed professionals who receive consideration for referring patients. This statute applies to individuals licensed under New Mexico law and prohibits the acceptance of any remuneration, directly or indirectly, in exchange for referring patients to a facility or provider for services. The statute does not explicitly address fee-splitting arrangements, but it emphasizes that any consideration received for a referral may be subject to disciplinary action by the licensing board. It is important to note that this statute focuses on the discipline of licensees rather than imposing a general prohibition on such arrangements.

In addition to this specific statute, New Mexico does not have broader state laws that explicitly address kickbacks or referral arrangements outside of the context of professional licensing. However, the federal Anti-Kickback Statute and Stark Law provide additional legal frameworks that may apply to healthcare providers operating in the state, even when federal funds are not involved.

Enforcement

Enforcement of New Mexico's anti-kickback and referral laws is primarily the responsibility of state licensing boards and regulatory agencies. For healthcare professionals, the New Mexico Medical Board, the New Mexico Board of Nursing, and other relevant licensing boards may take disciplinary action under N.M. Stat. § 61-6-15 if violations are found. These boards have the authority to impose sanctions, including license suspension or revocation, depending on the nature and severity of the violation. Additionally, the New Mexico Office of the Attorney General may be involved in broader enforcement actions involving fraudulent or illegal referral schemes.

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

To better understand how New Mexico's laws interact with federal anti-kickback and referral regulations, refer to the following resources: /practice-areas/ for an overview of key legal 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 insights on safe harbors, /aks-and-stark-law-how-the-two-regimes-overlap-in-healthcare-investigations/ for an analysis of how these regimes intersect, /recent-antikickback-statute-decisions/ for recent legal developments, and /faq/ for frequently asked questions.