Ohio Anti-Kickback & Referral Laws

Ohio Anti-Kickback Law at a Glance

Ohio’s anti-kickback and referral laws are primarily governed by state statutes that prohibit self-referrals for designated health services unless specific exceptions apply. These laws are designed to prevent conflicts of interest and ensure that healthcare decisions are made in the best interest of patients. While Ohio does not have a broad fee-splitting statute like some other states, it does impose strict limitations on certain types of self-referrals, particularly those involving designated health services. These restrictions intersect with federal anti-kickback and Stark Law provisions, which also apply in Ohio, particularly when federal health care programs are involved.

State Statutes

Ohio Rev. Code § 4731.66 prohibits a physician, dentist, or other licensed health care provider from referring a patient for a designated health service to an entity in which the provider has a financial interest, unless an exception applies. This statute mirrors the core principle of the federal Stark Law, which prohibits physician self-referrals for designated health services payable by Medicare or Medicaid. However, Ohio’s statute does not extend to all federal health care programs and applies to a broader range of health care providers and entities. Exceptions to the statute include arrangements that are part of a valid corporate practice of medicine, certain joint ventures, and referrals that are made in the best interest of the patient and not primarily for financial gain.

While Ohio does not have a separate fee-splitting statute, the prohibitions under Ohio Rev. Code § 4731.66 may apply in situations where financial arrangements between health care providers and entities could be viewed as incentivizing referrals. These provisions are complemented by federal anti-kickback laws, which impose broader prohibitions on remuneration intended to induce or reward referrals for items or services payable by federal health care programs.

Enforcement

Enforcement of Ohio’s anti-kickback and referral laws is primarily carried out by state licensing boards, including the Ohio State Medical Board, the Ohio Dental Board, and other relevant licensing authorities. These boards have the authority to investigate and discipline providers who violate referral and fee-splitting rules. In addition, the Ohio Attorney General’s Office may be involved in enforcement actions, particularly in cases involving fraud, abuse, or violations that affect the public interest.

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

Ohio’s anti-kickback and referral laws interact with federal regimes in complex ways, especially for providers involved in both state and federal health care programs. For further analysis, see /practice-areas/ for an overview of key research topics, /the-anti-kickback-statute-explained-why-referral-payments-trigger-scrutiny/ for a deeper dive into the Anti-Kickback Statute, /safe-harbors-under-the-anti-kickback-statute-and-where-providers-get-tripped-up/ for safe harbor considerations, /aks-and-stark-law-how-the-two-regimes-overlap-in-healthcare-investigations/ for how the two regimes intersect, /recent-antikickback-statute-decisions/ for recent case law, and /faq/ for common questions and answers.