AHD-COMP-003 — EKRA Risk Register v0.1
Status: DRAFT v0.1
Background
EKRA (Eliminating Kickbacks in Recovery Act, 18 USC 220) prohibits knowingly and willfully soliciting, receiving, or paying remuneration in exchange for referring a patient to a recovery home, clinical treatment facility, or laboratory.
Federal criminal offense. Penalties: up to 10 years imprisonment + $200,000 per violation, per referral.
Avina Home Detox Risk Lines
| Risk | Severity | Mitigation |
|---|---|---|
| Paying a clinician per referral | Catastrophic | Never structure compensation per referral. All clinician compensation is for services rendered. |
| Receiving payment from a residential facility for referring a principal post-detox | High | Decline all referral-fee offers. Document the decline. |
| Paying a family-office advisor per referral | Catastrophic | Never. The senior advisor is referred to as a clinical/business peer; no transactional relationship. |
| Bonus structure for nurses tied to case volume | Medium | Bonuses tied to clinical performance, training completion, and tenure — not to case acceptance or retention. |
| Marketing relationship with concierge MD that pays per patient | Catastrophic | Marketing relationships are flat-fee or commission-free. |
| Lab partnership for drug testing with kickback structure | Catastrophic | All lab work commissioned at fair market value. |
Florida State Analog (§817.505)
Per NEXUS regulatory research: Florida patient-brokering statute is felony with lower proof threshold than federal EKRA. Actively prosecuted by DCF. Same operational discipline applies in FL operations.
US v. Schena (9th Cir. July 2025)
Per NEXUS finding: percentage-based marketing compensation NOT per se EKRA violation; requires “wrongful causation” intent. Helpful for CA marketing structures but does not authorize volume-correlated comp.
Operating Discipline
- Every clinician compensated per Medical Director Agreement or 1099/W-2 agreement; no per-referral component.
- Every referral made by AHD on clinical fit only; no fee accepted.
- Every referral received by AHD on clinical fit only; no fee paid.
- Counsel reviews every new referral relationship structure before commencement.
- Documentation in EKRA Compliance File maintained by Medical Director and Avina Wellness GC.