Why these offers are regulated
The federal Eliminating Kickbacks in Recovery Act, at 18 U.S.C. §220, makes it a crime, for services covered by a health care benefit program, to pay or offer anything of value in exchange for someone using the services of a recovery home, clinical treatment facility or laboratory. It also covers paying for referrals. Penalties include large fines and prison.
The concern is that a person in crisis may choose a program because of what is offered rather than because it suits their needs. This guide cannot tell you whether a particular offer is lawful or how the law applies to you. It can help you ask questions that make the offer clearer.
Waiving what you owe
A program offering to waive your copayment, coinsurance or deductible may sound generous. Federal law treats this carefully. The kickback law includes an exception for a waiver or discount of coinsurance or a copayment, but only if the waiver is not routinely offered and is given in good faith.
In practice, a program that tells everyone “you won't pay anything, we'll take care of your share” as part of its pitch is a reason to ask more questions. You can ask: “Is this based on a financial hardship policy? Is it in writing? Does my insurer know?” A genuine financial assistance policy should be something the program can show you, with the same rules for everyone who qualifies.
Travel and housing offers in California
California has specific rules. California Health and Safety Code §11831.65 says licensed and certified programs may offer transportation to someone seeking treatment only if certain conditions are met. For ground travel, the distance must be under 125 miles. Air travel must include a return ticket the person can use after discharge, and the program must make an unused return ticket available on request for a year after discharge.
The same section allows discounted housing after discharge only under conditions, including a separate written housing contract and a repayment plan, and housing that is not tied to using the program's outpatient services. A separate section, §11831.6, bars programs and their staff from giving or receiving anything of value for referring someone for treatment.
Recruiters and call centers in Texas
Texas regulates how treatment facilities market themselves. Texas Health and Safety Code chapter 164 says a facility may not contact a potential patient to solicit a referral without disclosing that the person contacting them is affiliated with the facility. It also restricts facilities from using call centers or websites to generate leads unless the terms of that arrangement are disclosed to the prospective patient.
That matters because you may speak to someone who sounds independent but is paid to steer callers to particular programs.
Questions to ask before you accept
Ask who is making the offer: the program itself, a separate company, a recruiter or a website that connects callers to programs. Ask whether that person or company is paid by the program.
Ask what the offer is conditional on. Do you have to attend a particular program, stay a certain length of time or move into a particular house afterward? What happens to the travel or housing if you leave early?
Ask for the offer in writing, including who pays for the return journey. Ask how the program will bill your insurance and what it expects you to pay.
Check the program's license with your state before you travel. A long-distance offer to a program you have never heard of is worth checking twice.
Choosing care on its merits
The more useful question is whether the program is right for you, apart from the offer. Would you consider it if there were no free flight or waived bill? Does it provide the level of care an assessment recommended, and does it have a plan for what happens after discharge?
If an offer feels like pressure, you are allowed to slow down. A legitimate program should be willing to answer questions, give you time and explain its costs in writing.
If something seems wrong
If you believe a program or recruiter has made an improper offer, you can raise it with the state agency that licenses treatment programs where the program operates, or with your insurer's fraud line. If you have already traveled and feel stranded or unsafe, call 911 in an emergency.
Activities from this guide
Your checklist
Read the steps now. A free account lets you save your own checklist.
- 1. Ask who is making the offer and who pays them
- 2. Get the offer in writing
- 3. Check the program's license
About this guide
AI-generated editorial image; it does not depict a real person or event discussed in this guide.
Examples in this guide are illustrative, not reported experiences.
SoberSphere provides independent general information, not individual medical, legal or financial advice. No provider referral, affiliate arrangement or specialist review is claimed.