The EKRA Law Banning Commission-Based Lab Sales Reps Remains In Effect

The EKRA Law Banning Commission-Based Lab Sales Reps Remains In Effect

The EKRA Law Banning Commission-Based Lab Sales Reps Remains In Effect

On October 24, 2018, The Eliminating Kickbacks in Recovery Act of 2018 (EKRA) became law (see LE, December 2018). EKRA was part of broader legislation (The SUPPORT Act) intended to address the national opioid crisis.

The EKRA law prohibits commission payments based on the number of patients referred to a laboratory, the number of tests performed, or the amount billed to or received from a “health care benefit program” (which includes commercial insurance plans as well as Medicare and Medicaid). EKRA applies to all laboratories (toxicology, molecular, routine clinical, anatomic pathology, et al.), not merely labs that perform testing for recovery homes and clinical treatment facilities. Violation of EKRA is punishable by a fine of up to $200,000 and/ or imprisonment of up to 10 years for each occurrence.

The American Clinical Laboratory Association and its largest member labs have lobbied to have EKRA narrowed so that it applies only to laboratories associated with substance abuse services. However, to date, no changes have been made to the EKRA law.

McDonald Hopkins’ attorney Rick Cooper says that although there are no changes to EKRA expected in the near term, there may eventually be some narrowing of the law made in the long horizon.

The EKRA Law Banning Commission-Based Lab Sales Reps Remains In Effect

When Will The EKRA Ban On Commission-Based Sales Reps Be Lifted?

When Will The EKRA Ban On Commission-Based Sales Reps Be Lifted?

As part of ongoing efforts to combat the nationwide opioid crisis, Congress enacted the SUPPORT for Patients and Communities Act (SUPPORT Act) effective October 24, 2018. As part of the SUPPORT Act, Congress enacted the Eliminating Kickbacks in Recovery Act of 2018 (EKRA) which banned all CLIA laboratories from paying commissions to sales reps based on the number of patients referred, test volume, or the amount billed to a commercial health plan (see LE, April 2019 and December 2018).

Despite the threat of substantial fines and/or imprisonment, most labs have not yet changed the way they pay their sales reps in the hope that the law will soon be amended and directed more narrowly at toxicology labs.

On an April 30 conference call, LabCorp CEO David King said he believed the EKRA law was misguided and unintentionally overbroad. “We have been working with the legislative leadership in the Department of Justice. There has been legislative amendment language submitted to the congressional committees of jurisdiction and it’s being evaluated by the Department of Justice to make sure that the fix that would address the over-inclusiveness of the language is acceptable to DOJ as well as to legislators. So we continue to be optimistic that we’re going to get this resolved, but we don’t have a good estimate on the timing.”