The Anti-Kickback Statute strictly applies to referrals that involve a federal healthcare program. Under the statute, federal healthcare program is defined as “any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the U.S. government.”
In 2013, HHS issued a non-binding letter that said under its interpretation of the definition of “federal healthcare program” subsidized insurance plans purchased on the exchanges would not be considered part of the federal health program, according to the report.
However, HHS has not issued formal guidance on the issue, which means courts are not bound by the statement issued in the non-binding letter. Therefore, federally subsidized health plans could still serve as the basis for Anti-Kickback and False Claims Act lawsuits.
More Articles on the Anti-Kickback Statute:
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