Tennessee Anti-Kickback & Referral Laws

Tennessee Anti-Kickback Law at a Glance

Tennessee's anti-kickback and referral laws focus primarily on prohibiting fee-splitting arrangements involving physician referrals. While the state does not have a comprehensive anti-kickback statute like some other jurisdictions, it does specifically criminalize certain conduct under Tenn. Code § 63-6-225(b), which makes it a misdemeanor for a physician to split fees for referring a patient. This statute reflects a narrower approach compared to federal laws, targeting only specific types of conduct. Tennessee’s legal framework thus interacts with broader federal anti-kickback and Stark Law provisions, particularly in cases involving federal healthcare programs.

State Statutes

Tenn. Code § 63-6-225(b) criminalizes the splitting of fees by a physician for referring a patient to another provider or facility. This provision is limited in scope, applying only to fee-splitting arrangements tied to referrals and not to more general kickback schemes. The statute is a misdemeanor offense, indicating a relatively low level of severity compared to federal felony penalties. It is important to note that this law does not extend to other forms of remuneration or referral-based arrangements, which may be governed by federal statutes instead.

Although Tennessee does not have a broader state-level anti-kickback law, the single statute cited above is the only verified provision related to referral and fee-splitting in the state. Other aspects of anti-kickback and referral law in Tennessee are governed by federal statutes and regulations, as well as by professional licensing and enforcement mechanisms.

Enforcement

Enforcement of Tennessee’s anti-kickback and referral laws is primarily handled by state licensing boards, including the Tennessee Board of Medical Examiners and the Tennessee Board of Nursing. These boards are responsible for investigating and disciplining violations of state medical and nursing licensing laws, including those related to fee-splitting and improper referral arrangements. In addition, the Tennessee Department of Commerce and Insurance may have a role in regulating certain insurance-related aspects of healthcare arrangements, though it is not directly responsible for enforcing the specific statute cited above.

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

Tennessee’s anti-kickback and referral laws are limited in scope and interact with federal regimes in specific ways. For further context and analysis, see related pages such as /practice-areas/ for research topics, /the-anti-kickback-statute-explained-why-referral-payments-trigger-scrutiny/ for a statutory explainer, /safe-harbors-under-the-anti-kickback-statute-and-where-providers-get-tripped-up/ for safe-harbor details, /aks-and-stark-law-how-the-two-regimes-overlap-in-healthcare-investigations/ for AKS/Stark overlap analysis, /recent-antikickback-statute-decisions/ for recent cases, and /faq/ for frequently asked questions.