Does the Anti-Kickback Act only apply to Brightstar Care patients covered by federal healthcare programs?
Brightstar_Care Franchise · 2025 FDDAnswer from 2025 FDD Document
g or other requirements for health care providers. In addition, almost all states prohibit the use or disclosure of individual's health information for purposes other than treatment, payment or internal health care operations. Civil and criminal fines or penalties may be imposed for the unauthorized use of health or financial information, and state authorities may impose remediation measures in the event of breaches of information security. You will be responsible for investigating and complying with any such laws that may apply in your territory.
b. Anti-Kickback Laws
Certain provisions of the Social Security Act, commonly referred to as the "Anti-Kickback Statute," prohibit the offer, payment, solicitation or receipt of any form of remuneration either in return for the referral of patients or patient care opportunities paid in whole or in part by a federal health care program, including but not limited to Medicare, Medicaid, and the VA, or in return for the recommendation, arrangement, purchase, lease or order of items or services paid in whole or in part by a federal health care program, including VA benefits.
The Anti-Kickback Act is broad in scope and has been broadly interpreted by courts in many jurisdictions. Violation of the Act constitutes a felony punishable by a maximum fine of $25,000, imprisonment up to five years, or both.
Source: Item 23 — RECEIPTS (FDD pages 118–387)
What This Means (2025 FDD)
According to Brightstar Care's 2025 Franchise Disclosure Document, the Anti-Kickback Statute primarily addresses remuneration related to patients or services paid by federal healthcare programs like Medicare, Medicaid, and the VA. This federal law prohibits offering, paying, soliciting, or receiving any form of payment in exchange for patient referrals or for recommending, arranging, purchasing, leasing, or ordering items or services covered by these federal programs. Violations can result in significant penalties, including fines up to $25,000, imprisonment for up to five years, and exclusion from federal healthcare programs.
However, the FDD also clarifies that many states have enacted their own anti-kickback laws. These state laws may apply more broadly to all patients, regardless of their insurance coverage. This means that even if a Brightstar Care client is not covered by a federal healthcare program, the franchisee could still be subject to state anti-kickback regulations.
Therefore, while the federal Anti-Kickback Statute focuses on federal healthcare programs, franchisees must also be aware of and comply with applicable state laws, which may have a wider scope. Brightstar Care advises franchisees to seek legal counsel to understand the specific anti-kickback laws that apply to their agency and referral practices.