Patient brokering is paying for patients, or being paid for them. In addiction treatment it is a crime under federal law and in states such as Florida, and it is most often committed through marketing: per-admission fees, paid "helplines", sober-home kickbacks and referral bonuses. This guide explains the laws through the marketing arrangements they reach, with hypothetical examples and questions to take to your attorney.
Search interest is modest but steady: about 140 US searches a month for "patient brokering" and 20 for "patient brokering laws" (Google Ads Keyword Planner data via DataForSEO, US, 12-month average to Sep 2026).
What patient brokering means
Patient brokering is the exchange of something of value for the referral of a patient. Money is the obvious case, but the laws reach anything given "directly or indirectly, overtly or covertly, in cash or in kind": free rent, travel, gift cards, a share of revenue or a "marketing fee" that happens to track admissions.
Both sides can be liable. The program that pays and the marketer, sober home or individual who receives can each commit the offense, and Florida's law also covers anyone who aids or abets it.
The marketing connection is direct. Most brokering schemes in this field look like lead generation from the outside, which is why every channel decision on our addiction treatment marketing map starts with how vendors are paid.
The federal law: EKRA, and how it differs from the Anti-Kickback Statute
The Eliminating Kickbacks in Recovery Act, or EKRA (18 U.S.C. § 220 (opens in a new tab)), makes it a federal crime to knowingly and willfully:
- solicit or receive remuneration in return for referring a patient to a recovery home, clinical treatment facility or laboratory; or
- pay or offer remuneration to induce such a referral, or in exchange for an individual using those services.
The penalty is a fine of up to $200,000, up to 10 years in prison, or both, "for each occurrence."
EKRA applies to services covered by a health care benefit program, which 18 U.S.C. § 24(b) (opens in a new tab) defines as "any public or private plan or contract, affecting commerce." Commercial insurance counts. Its definition of a clinical treatment facility explicitly includes "outpatient treatment and care" as well as detox and residential treatment under state licensure or certification.
| Item | EKRA (18 U.S.C. § 220) | Anti-Kickback Statute (42 U.S.C. § 1320a-7b) |
|---|---|---|
| Services covered | Recovery homes, clinical treatment facilities and laboratories | Any item or service payable by federal health care programs |
| Payers | Any health care benefit program, public or private | Federal health care programs such as Medicare and Medicaid |
| Exceptions | Eight statutory exceptions, narrower than AKS safe harbors | Regulatory safe harbors; an arrangement must "fit squarely" in one |
| Overlap | Does not apply to conduct already prohibited by the AKS | Applies on its own terms |
The HHS Office of Inspector General (opens in a new tab) describes the AKS as prohibiting "the knowing and willful payment of 'remuneration' to induce or reward patient referrals," with criminal fines, prison and exclusion from federal programs.
The EKRA exception marketers ask about most covers payments to bona fide employees and independent contractors, but only if the pay "is not determined by or does not vary by" the number of individuals referred, the number of tests or procedures performed, or the amount billed. A business development rep paid per admission doesn't fit it.
State patient-brokering laws
States add their own statutes, often with broader reach than EKRA. Florida's is the best-known example.
Florida's Patient Brokering Act (§ 817.505) (opens in a new tab) makes it a crime to offer or pay "a commission, benefit, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind" to induce patient referrals, to solicit or receive one, or to aid or abet either. The penalties scale with the number of patients:
| Patients involved | Offense | Mandatory fine |
|---|---|---|
| Any violation | Third-degree felony | $50,000 |
| 10 to 19 | Second-degree felony | $100,000 |
| 20 or more | First-degree felony | $500,000 |
Florida's deceptive marketing statute (§ 397.55) (opens in a new tab) applies to treatment providers, recovery residences and the third parties that market for them. It treats patient brokering as a deceptive marketing practice and requires call-center and web lead generators to disclose which licensed providers pay them.
Other states have their own laws, and the details differ. Check your state's statute with counsel before signing any referral or marketing arrangement.
This is general information, not legal advice. Confirm how it applies to your practice with a qualified advisor.
Marketing arrangements that raise brokering risk
Each example below is invented to show a pattern. None describes a real program.
Hypothetical example (higher risk): An IOP pays a marketing firm $3,000 for each caller from its "recovery helpline" site who completes admission. The firm also answers calls for two other programs.
Payment rises with each patient, the caller doesn't know who is answering, and the firm is a lead generator that LegitScript won't certify.
Hypothetical example (higher risk): A sober living home receives a monthly "case management" payment from an outpatient program equal to $500 for each resident enrolled there.
Remuneration tied to residents enrolled is the core EKRA pattern, whatever the invoice calls it.
Hypothetical example (higher risk): A program pays alumni a $250 gift card for every friend who enters treatment.
Small amounts and kind intentions don't change the structure: value given in exchange for a referral.
Hypothetical example (higher risk): A program routinely waives copays and covers flights for out-of-state admissions.
EKRA's exception for copay waivers requires that they are "not routinely provided" and are given in good faith, and LegitScript disqualifies programs that pay for patient travel.
Our guide to healthcare lead generation explains why per-lead buying also tends to bring poor-fit callers.
Safer structures: flat fees, owned channels and transparent intake
Lower-risk marketing has three features: pay doesn't track patients, the channels belong to you, and callers know who they're talking to.
Hypothetical example (lower risk): The same IOP pays an agency a flat monthly fee for its website, Google Business Profile and, once certified, ads run in the program's own accounts. Calls ring the program's admissions team. Reports show calls and admissions by source in aggregate.
Hypothetical example (lower risk): The program builds relationships with three primary care practices and a hospital social work team. It offers fast assessments and, with patient consent, updates to the referring clinician. No one is paid for referrals.
Hypothetical example (lower risk): Business development staff are salaried. Any bonus is tied to measures that don't count referrals or amounts billed, and counsel reviewed the plan.
Owned channels also help with platform rules. Google and Meta require LegitScript certification before treatment ads run; see rehab advertising rules. Intake records may be protected under 42 CFR Part 2, so keep vendors away from them unless the right agreements are in place.
How Medfy charges. Medfy charges a flat monthly subscription: $349 for the base plan, with add-ons at fixed monthly prices. Ad spend is paid directly to Google and Meta, never marked up. Those are pricing facts, not a legal opinion about any arrangement. Medfy also does not provide LegitScript certification, and its commitments cover HIPAA-protected data under a BAA; its handling of 42 CFR Part 2 records is not confirmed, so substance-use intake should stay in your program's own Part 2-compliant systems.
What to ask agencies and referral partners
Take these questions to every vendor and referral relationship, and the answers to your attorney:
- Does any payment between us vary with calls, leads, admissions, census or amounts billed?
- Does either side give the other anything of value: rent, staff time, travel, gifts, shared revenue?
- Do you market or refer for any other program? Will callers know who they're talking to?
- Whose name is on the phone numbers, websites and ad accounts?
- Do you own or operate any helpline, directory or lead-generation site?
- If you're a recovery residence, how do residents choose their treatment provider?
- Is the arrangement in writing, at a fixed fee for defined services, and reviewed by counsel?
- Will you receive patient information, and under which agreement?
For agency-specific questions, see vetting a rehab marketing agency. For a neutral look at your current marketing, the free marketing audit reads public information only and scores your website, listings, AI visibility and ads.
Frequently asked questions
What is patient brokering?
Patient brokering means paying, or accepting, anything of value in exchange for steering a patient to a provider. In addiction treatment it usually looks like per-admission fees to marketers, payments or free rent to sober homes for residents who enroll, or bonuses to staff for each referral. Federal law (EKRA, 18 U.S.C. § 220) and state laws such as Florida's Patient Brokering Act make these arrangements crimes.
Is paying for leads considered patient brokering?
It can be. EKRA covers remuneration paid to induce a referral or in exchange for an individual using a treatment facility's services, and state laws are similar. A fee per call, per lead or per admission ties payment to patients, which is the pattern these laws target. Flat fees for defined marketing work are a common lower-risk alternative. Because the line depends on facts, get a healthcare attorney's opinion before buying leads.
Does EKRA apply to outpatient programs?
Yes. EKRA covers clinical treatment facilities, which the statute defines as medical settings other than hospitals that provide detoxification, risk reduction, outpatient treatment and care, residential treatment or rehabilitation for substance use under state licensure or certification. It also covers recovery homes and laboratories. It applies to services covered by a health care benefit program, a term that includes private as well as public plans.
Can a treatment center pay a marketing agency per admission?
It carries serious risk. EKRA's exception for employees and contractors applies only when pay is not determined by and does not vary with the number of people referred or the amounts billed, and per-admission pay does exactly that. Florida's Patient Brokering Act adds felony penalties, and other states have their own laws. Pay agencies a flat fee for defined work, and have counsel review any outcome-based term.