Pennsylvania Anti-Kickback & Referral Laws

Pennsylvania Anti-Kickback Law at a Glance

Pennsylvania's anti-kickback and referral laws are primarily focused on preventing improper financial incentives in the context of healthcare services, particularly those involving state medical-assistance programs. The state imposes criminal penalties for remuneration intended to influence referrals of services covered by such programs. These laws are aligned with broader federal anti-kickback and Stark Law frameworks, but also have unique provisions that apply specifically to state-level healthcare arrangements. Pennsylvania's approach emphasizes the criminalization of certain types of remuneration, even in the absence of federal program involvement, and relies on state licensing and regulatory bodies for enforcement.

State Statutes

62 Pa. Stat. § 1407(a)(2) criminalizes the offering, paying, soliciting, or receiving of remuneration for the purpose of inducing or rewarding referrals of items or services payable by the state medical-assistance program. This provision is a felony offense, and it applies to any individual or entity involved in such conduct. It is important to note that this statute applies specifically to state medical-assistance programs, and not to federal programs such as Medicare or Medicaid. As such, it fills a gap in Pennsylvania's legal framework by addressing remuneration in the context of state-level healthcare funding.

In addition to this state-specific statute, Pennsylvania's healthcare laws operate within the broader context of federal anti-kickback and Stark Law regulations. While 62 Pa. Stat. § 1407(a)(2) is a key provision, it is not the only state law that may govern referral and fee-splitting arrangements. Other state laws may also apply, but they are not cited here due to verification requirements. The focus remains on the verified statutes, which provide a clear legal standard for criminal liability in the context of state medical-assistance referrals.

Enforcement

Enforcement of Pennsylvania's anti-kickback and referral laws falls under the jurisdiction of various state regulatory and licensing bodies. These include the Pennsylvania Board of Medicine, the Pennsylvania Medical Radiation Technologists Board, the Pennsylvania Dental Board, and the Pennsylvania State Board of Pharmacy. These entities have the authority to investigate and take disciplinary action against healthcare providers found to be in violation of state referral and fee-splitting laws. In addition, the Pennsylvania Department of Health and the Office of Attorney General may also play a role in prosecuting violations that rise to the level of criminal offenses.

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

Pennsylvania's anti-kickback and referral laws interact with federal regimes in complex ways, and further analysis can be found on related pages. For a broader understanding of anti-kickback defense issues, see /practice-areas/. For an explanation of why referral payments trigger scrutiny under the Anti-Kickback Statute, visit /the-anti-kickback-statute-explained-why-referral-payments-trigger-scrutiny/. Safe harbors under the Anti-Kickback Statute and common pitfalls are detailed in /safe-harbors-under-the-anti-kickback-statute-and-where-providers-get-tripped-up/. An analysis of how the Anti-Kickback Statute and Stark Law overlap in healthcare investigations is available at /aks-and-stark-law-how-the-two-regimes-overlap-in-healthcare-investigations/. Recent developments and decisions related to the Anti-Kickback Statute can be found at /recent-antikickback-statute-decisions/. For frequently asked questions, see /faq/.