The federal Anti-Kickback Statute prohibits remuneration in relation to the provision of a “good, facility, service, or item for which payment may be made in whole or in part under a Federal health care program.” 42 U.S.C. § 1320a-7b(b). The Anti-Kickback Statute goes on to define “federal health care program” as any government funded plan or program that provides health benefits or any state health care program. 42 U.S.C. § 1320a-7b(f). The list of federal and state programs to which the Anti-Kickback Statute applies is extensive. State programs that are included in the following list receive some level of federal funding.
- Medicare (including several managed care plans that contract with Medicare);
- Medical Assistance or Medicaid (including managed care plans that contract with the various state Medicaid Programs);
- State Children’s Health Insurance Program (CHIP or SCHIP);
- TRICARE and Tricare for Life;
- Veterans Administration (VA) Services;
- Indian Health Services (IHS);
- Federal Health Program for Alaska Natives;
- Railroad Employees National Health and Welfare Plan (RENHWP);
- Federal Employees’ Compensation Act (FECA) program;
- Longshore and Harbor Workers’ Compensation Act (LHWCA);
- Federal Black Lung Benefits Act program (FBLBA);
- Energy Employees Occupational Illness Compensation Program Act (EEOIC) (also known as the “Beryllium Exposure Compensation Act”) program;
- Refugee Medical Assistance (RMA) program;
- Federal Reimbursement of Emergency Health Services to Undocumented Aliens program; and
- Ryan White HIV/AIDS Program.
These programs cover a very significant portion of all health services furnished in the United States. Therefore, nearly every medical item, facility, service, or equipment is potentially payable by a federal health care program.
Note, however, the Federal Employee Health Benefit (FEHB) Program, the program that provides insurance and benefits to federal civilian employees, is not included in the above list of payers, by statutory exemption. 42 U.S.C. § 1320a-7b(f); 5 U.S.C. Ch. 89.
The Public Health Service (PHS) and its programs may also be excluded from application. See 42 U.S.C. § 1320a-7b(b)(3)(D).