If you market a treatment center or buy software for one, EKRA is a law you cannot afford to misunderstand. It's short, it's broad, and it has put real people in real trouble. This is a plain-English explainer — not legal advice, but enough to ask the right questions and avoid the most common traps.
This article is educational and not a substitute for advice from a qualified healthcare attorney.
What EKRA is
EKRA — the Eliminate Kickbacks in Recovery Act — is a federal law passed in 2018. It was written to crack down on patient brokering in the addiction treatment and lab-testing world. In short: it makes it a federal crime to pay, or receive payment, in exchange for referring patients to certain treatment facilities, recovery homes, or labs.
Why it's broader than people expect
Unlike the older Anti-Kickback Statute, EKRA applies regardless of who's paying — it covers private insurance and cash-pay, not just federal programs. It also reaches marketing arrangements. That means a marketing vendor, call center, or even an employee comp plan structured around the number of patients brought in can fall under it.
The penalties are not small
- Up to $200,000 in fines per violation.
- Up to 10 years in prison per violation.
- Both can apply to individuals — owners, marketers, and staff — not just the company.
What this means for the software you buy
Here's the practical takeaway for vendors and tools: any arrangement where you pay based on specific patients or referrals is a red flag. If an alumni platform, lead service, or marketing tool charges per-patient, per-admission, or takes a percentage tied to individuals it sends you — that's exactly the structure EKRA was written to punish.
The safe model: flat fees
Flat-fee, subscription-based services that are paid the same regardless of patient volume are the standard safe-harbor approach. You're paying for a tool or a service, not for bodies. That distinction is everything.
Questions to ask every vendor
- Is your pricing flat-fee, or tied to patients/referrals?
- Does any part of what I pay change based on how many clients I enroll?
- Can you put the flat-fee structure in writing?
- Have you had healthcare counsel review your model against EKRA?
How Still Here is structured
Still Here charges a flat monthly subscription with zero per-patient or referral fees — by design. It's an alumni aftercare and peer-support tool you license, not a referral service. That keeps the EKRA question simple. See how the pricing works →
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