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Of course, healthcare providers make many referrals that do not violate the Anti-Kickback Statute by taking advantage of the “safe harbors” that are written into the statute and exempt certain referral arrangements from its prohibitions. While healthcare providers often structure referral arrangements to fit within one or more of the “safe harbors” to avoid being investigated, the “safe harbors” also often provide some of the best legal refuges for providers who are accused of civil or criminal violations of the statute.i
Safe harbors include:ii
- Investments in large publicly-held health care companies
- Investments in small healthcare joint ventures
- Space rental
- Equipment rental
- Personal services and management contracts
- Sales of retiring physicians’ practices to other physicians
- Referral services
- Warranties
- Discounts
- Employee compensation
- Group purchasing organizations
- Waivers of Medicare part an inpatient cost-sharing amount
- Increased coverage
- Reduced cost-sharing amounts or reduced premium amounts offered by health plans to beneficiaries
- Price reductions offered to health plans by providers
- Investments in Ambulatory Surgical Centers (ASC)
- Joint ventures in underserved areas
- Practitioner recruitment in underserved areas
- Sales of physician practices to hospitals in underserved areas
- Subsidies for obstetrical malpractice insurance in underserved areas
- Investments in group practices
- Specialty referral arrangements between providers
- Cooperative hospital services organizations