Top Enforcement Trends Under the Anti-Kickback Statute: How DOJ and OIG Are Targeting Kickback Schemes

The Anti-Kickback Statute (“AKS”) sets the rules of the road for financial relationships in healthcare. But enforcement priorities shift over time as new business models emerge, healthcare delivery evolves, and regulators sharpen their focus. For executives, investors, operators, and compliance officers, understanding current enforcement trends is just as important as knowing the statute itself.

In recent years, the U.S. Department of Justice (“DOJ”) and the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) have expanded investigations, brought more cases, and coordinated with whistleblowers at record levels. These efforts signal where the government sees the greatest risk — and where healthcare stakeholders must exercise the most caution.

Telehealth Platforms and Lead Generation

Telehealth surged in adoption during and after the COVID-19 pandemic, but with growth came scrutiny. Regulators have flagged arrangements where marketing companies receive payment based on the volume of patient leads or where telehealth providers rely on referral-driven structures. DOJ and OIG view these models as high risk because they can incentivize unnecessary services, distort medical judgment, and drive up program costs.

For operators and investors, telehealth compliance requires extra attention to how leads are generated, how compensation flows, and whether arrangements align with fair market value.

Private Equity-Backed Provider Groups

Private equity continues to reshape the healthcare landscape through roll-ups and management services organization (“MSO”) structures. Regulators increasingly question whether financial incentives tied to return on investment improperly influence physician behavior or referral patterns. DOJ has emphasized that investor-backed deals do not get a pass. Instead, the agency has launched investigations into MSO arrangements, acquisition structures, and compensation models that appear to reward volume over value.

For executives and investors, the takeaway is clear: AKS diligence belongs at the front end of every deal. Ignoring compliance risk can reduce valuations, create successor liability, and erode trust with regulators.

Whistleblower Cases on the Rise

The False Claims Act continues to empower whistleblowers — often insiders with detailed knowledge — to bring AKS-related claims. Whistleblowers receive between 15% and 30% of any recovery, giving them strong incentives to report. Many of the government’s largest healthcare settlements in recent years originated from whistleblower complaints.

Organizations must assume that if a questionable arrangement exists, someone within the company may raise it. Compliance programs that encourage internal reporting and address concerns early can reduce the risk of external complaints.

Data-Driven Investigations

Federal agencies now rely heavily on data analytics to identify anomalies in billing, referral patterns, and provider behavior. Advanced systems flag providers who deviate from peer averages or whose referral streams suggest improper influence. Regulators then use those data patterns to open investigations, even when no whistleblower steps forward.

Operators and compliance officers should view internal data the same way regulators do. Regular analytics reviews can help organizations detect and correct issues before DOJ or OIG comes knocking.

What These Trends Mean for Stakeholders

Enforcement priorities highlight more than just areas of risk. They show where regulators believe improper financial incentives harm patients and federal programs. For healthcare stakeholders, these trends mean:

• Executives must integrate AKS considerations into strategic planning.
• Investors must evaluate AKS risk during diligence and price deals accordingly.
• Operators must monitor compensation and vendor contracts for red flags.
• Compliance officers must strengthen reporting systems and analytics tools.

Conclusion

AKS enforcement continues to evolve, but the message from DOJ and OIG is consistent: financial arrangements that drive referrals or inflate costs will draw scrutiny. By understanding current enforcement trends, executives, investors, operators, and compliance officers can stay ahead of investigations, protect enterprise value, and avoid costly settlements.

This post is for informational purposes only and does not constitute legal advice. For guidance tailored to your organization, contact Mooradian Law at info@mooradian.law or (734) 219-4890.