---
title: "What Is the Anti-Kickback Statute? Definition and Reach"
description: "The Anti-Kickback Statute bans paying for referrals of federal health care program business. What it covers, its safe harbors and its reach for cash-pay care."
canonical: "https://cuvo.co/glossary/anti-kickback-statute"
last-updated: "Oct 26, 2026"
---
**Definition:** The federal Anti-Kickback Statute, 42 U.S.C. 1320a-7b(b), makes it a felony to knowingly and willfully offer, pay, solicit or receive anything of value to induce or reward referrals of items or services payable in whole or in part by a federal health care program such as Medicare or Medicaid.

# What is the Anti-Kickback Statute?

The Anti-Kickback Statute is the federal criminal law against paying for referrals in Medicare, Medicaid and other federal health care programs. Its reach is narrower than its reputation for cash-pay care, and state laws fill the gap. Cuvo Health runs cash-pay programs on flat, published fees.

Published Oct 26, 2026. Facts reviewed Oct 26, 2026.

The federal Anti-Kickback Statute, 42 U.S.C. 1320a-7b(b), makes it a felony to knowingly and willfully offer, pay, solicit or receive any remuneration, in cash or in kind, to induce or reward referrals of items or services payable in whole or in part by a federal health care program such as Medicare or Medicaid. It binds both sides of the payment and anyone in the chain, not only clinicians. Its reach turns on federal program business, so a cash-pay program is analyzed mainly under state laws, several of which are not limited to federal program business. On Cuvo Health, programs are cash-pay with no insurance dependencies, and Cuvo charges brands flat, published fees with no revenue share.

**At a glance**
- Citation: 42 U.S.C. 1320a-7b(b); safe harbors at 42 CFR 1001.952
- Who it covers: Anyone who offers, pays, solicits or receives remuneration for referrals
- What business: Items or services payable by a federal health care program
- Intent: Knowing and willful; no need to know the statute itself
- On Cuvo: Cash-pay programs, flat published fees, no revenue share

**What the federal statute reaches, and what sits beside it (text checked October 26, 2026)**

| Question | Answer | Source |
| --- | --- | --- |
| **Who is covered** | Anyone who offers or pays, and anyone who solicits or receives, remuneration | 42 U.S.C. 1320a-7b(b)(1) and (b)(2) |
| **Which business** | Items or services payable in whole or in part by a federal health care program, which excludes the federal employees' health benefits program | 1320a-7b(b) and (f) |
| **Intent** | Knowing and willful; actual knowledge of the statute or specific intent to violate it is not required | 1320a-7b(h) |
| **Penalties** | Felony fines up to $100,000, up to 10 years in prison, or both; civil monetary penalties; tainted claims become false claims | 1320a-7b(b), 1320a-7a(a)(7), 1320a-7b(g) |
| **Protected arrangements** | Safe harbors, including personal services and management contracts | 42 CFR 1001.952(d) |
| **State laws beside it** | Referral-payment, fee-splitting and patient brokering statutes, some with carve-outs keyed to the federal statute | California Business and Professions Code 650, Florida 458.331(1)(i) and 817.505, Texas Occupations Code 102.001 |

## 01. Does the Anti-Kickback Statute apply to cash-pay telehealth?

The federal statute reaches remuneration tied to items or services for which payment may be made, in whole or in part, under a federal health care program. Where nothing in an arrangement is payable by Medicare, Medicaid or another federal program, that element is missing, which is why cash-pay telehealth is analyzed mainly under state law. State statutes are broader. California Business and Professions Code section 650(a) makes referral compensation by a licensee unlawful with no payer limit, and Florida section 458.331(1)(i) makes split-fee referral arrangements grounds for disciplining a physician. Florida's patient brokering act (817.505) and Texas Occupations Code section 102.001 also reach referral payments by any person, though each carves out practices keyed to the federal statute (817.505(3)(a), 102.003), so counsel reads the two together.

## 02. What are the Anti-Kickback safe harbors?

Payment practices listed at 42 CFR 1001.952 that are not treated as a criminal offense under the statute and cannot ground an exclusion. HHS-OIG's guidance says an arrangement must fit a safe harbor squarely and meet all of its requirements. The personal services and management contracts safe harbor at section 1001.952(d)(1) asks for a signed written agreement covering all services, a term of at least one year, and a compensation methodology set in advance, consistent with fair market value and not tied to the volume or value of federal program referrals.

## 03. How is the Anti-Kickback Statute different from the Stark Law?

The Anti-Kickback Statute is a criminal intent statute that covers anyone and any federal program item or service. The Stark Law, 42 U.S.C. 1395nn, is a civil, strict liability rule limited to physician referrals for designated health services payable by Medicare, and by Medicaid through 42 U.S.C. 1396b(s). One arrangement can raise both.

## 04. Why does the Anti-Kickback Statute matter for a telehealth brand?

Because the payments a growing brand makes, to marketing partners, clinicians, labs and pharmacies, are the kind the statute and its state counterparts address whenever any part of a patient's care is payable by a federal health care program. Counsel reviews each arrangement against both, and a structure that pays per referral is the first one tested.

## Frequently asked questions

**Q: What is the Anti-Kickback Statute?**

A: It is the federal criminal law, 42 U.S.C. 1320a-7b(b), that bars knowingly and willfully paying or receiving anything of value for referrals of items or services payable by a federal health care program. On Cuvo, programs are cash-pay with no insurance dependencies, and Cuvo charges brands flat, published fees.

**Q: Does the Anti-Kickback Statute apply to cash-pay practices?**

A: The federal statute turns on items or services payable by a federal health care program, so a program with no such payment falls mainly under state law instead, such as California Business and Professions Code section 650. Cuvo Health runs cash-pay programs and takes no revenue share.

**Q: What are the penalties for violating the Anti-Kickback Statute?**

A: It is a felony punishable by fines of up to $100,000 and up to 10 years in prison per the statute, plus civil monetary penalties and False Claims Act liability for resulting claims. On Cuvo, the brand's costs are flat and published, with no revenue share.

**Q: Stark Law vs Anti-Kickback Statute: what is the difference?**

A: The Anti-Kickback Statute is a criminal intent law covering anyone and any federal program business; the Stark Law is a civil strict liability rule on physician referrals for Medicare and Medicaid designated health services. On Cuvo, programs are cash-pay with no insurance dependencies.

**Q: What is an Anti-Kickback safe harbor?**

A: It is a payment practice listed at 42 CFR 1001.952 that is not treated as a crime under the statute if every condition is met, such as the personal services and management contracts safe harbor. On Cuvo, the MSO structure and its agreement are built and maintained by Cuvo.

**Related pages**

- [Stark Law](/glossary/stark-law): The civil physician self-referral rule
- [Fair market value in healthcare](/glossary/fair-market-value-healthcare): The pricing test safe harbors rely on
- [Fee-splitting laws](/glossary/fee-splitting): The state rules beside the federal statute
- [Add GLP-1, peptides and TRT to a gym or fitness brand](/blog/add-glp1-peptides-and-trt-to-a-gym-or-fitness-brand): Referral models and patient brokering, in practice
- [Cuvo compliance](/compliance): The structure Cuvo builds and maintains for every brand

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