North Dakota Anti-Kickback & Referral Laws

North Dakota Anti-Kickback Law at a Glance

North Dakota's anti-kickback and referral laws are primarily governed by state statutes that address the criminalization of remuneration for referrals involving state programs. These laws influence healthcare arrangements by imposing restrictions on fee-splitting and referral practices that could lead to improper financial incentives. While North Dakota does not have a comprehensive state statute comparable to the federal Anti-Kickback Statute, the state does have specific provisions that apply to certain healthcare-related transactions, particularly those involving state-funded programs. These laws are often considered in conjunction with federal anti-kickback and Stark Law provisions, especially in cases involving Medicare or Medicaid.

State Statutes

N.D. Cent. Code § 50-24.8-11(1) criminalizes the offering, paying, soliciting, or receiving of remuneration for the purpose of inducing or rewarding referrals of items or services payable by a state healthcare program. This statute applies specifically to referrals related to state-funded programs and is not limited to healthcare providers alone. The law is designed to prevent improper financial incentives that could compromise the integrity of state-sponsored healthcare services. Unlike the federal Anti-Kickback Statute, which applies broadly to all federal healthcare programs, this state provision is narrower in scope, focusing on state-specific funding.

In addition to the above, North Dakota does not have a separate state statute that explicitly prohibits physician self-referrals or fee-splitting in the same manner as the Stark Law. Therefore, the primary legal framework for anti-kickback and referral matters in North Dakota is largely shaped by the federal anti-kickback and Stark Law regimes, with the exception of the specific provision under N.D. Cent. Code § 50-24.8-11(1), which applies to state healthcare programs.

Enforcement

Enforcement of North Dakota's anti-kickback and referral laws is typically handled by state licensing boards and regulatory agencies responsible for overseeing healthcare professionals and facilities. These include the North Dakota Department of Health, the North Dakota Medical Board, and other state licensing entities. These bodies may investigate allegations of illegal remuneration for referrals and impose disciplinary actions, including fines, license suspensions, or revocations, depending on the severity of the violation.

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

North Dakota's anti-kickback and referral laws interact with federal regimes in complex ways, particularly when state and federal programs overlap. For further analysis of these interactions, including legal defenses, statutory explanations, safe harbors, and case law, see /practice-areas/, /the-anti-kickback-statute-explained-why-referral-payments-trigger-scrutiny/, /safe-harbors-under-the-anti-kickback-statute-and-where-providers-get-tripped-up/, /aks-and-stark-law-how-the-two-regimes-overlap-in-healthcare-investigations/, /recent-antikickback-statute-decisions/, and /faq/.