U.S. Code » Title 18 » Part PART I— CRIMES › Chapter CHAPTER 11— BRIBERY, GRAFT, AND CONFLICTS OF INTEREST

18 U.S.C. § 220

Illegal remunerations for referrals to recovery homes, clinical treatment facilities, and laboratories

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(a)Offense.—Except as provided in subsection (b), whoever, with respect to services covered by a health care benefit program, in or affecting interstate or foreign commerce, knowingly and willfully—(1) solicits or receives any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind, in return for referring a patient or patronage to a recovery home, clinical treatment facility, or laboratory; or(2) pays or offers any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind—(A) to induce a referral of an individual to a recovery home, clinical treatment facility, or laboratory; or(B) in exchange for an individual using the services of that recovery home, clinical treatment facility, or laboratory,shall be fined not more than $200,000, imprisoned not more than 10 years, or both, for each occurrence.(b)Applicability.—Subsection (a) shall not apply to—(1) a discount or other reduction in price obtained by a provider of services or other entity under a health care benefit program if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider or entity;(2) a payment made by an employer to an employee or independent contractor (who has a bona fide employment or contractual relationship with such employer) for employment, if the employee’s payment is not determined by or does not vary by—(A) the number of individuals referred to a particular recovery home, clinical treatment facility, or laboratory;(B) the number of tests or procedures performed; or(C) the amount billed to or received from, in part or in whole, the health care benefit program from the individuals referred to a particular recovery home, clinical treatment facility, or laboratory;(3) a discount in the price of an applicable drug of a manufacturer that is furnished to an applicable beneficiary under the Medicare coverage gap discount program under section 1860D–14A(g) of the Social Security Act (42 U.S.C. 1395w–114a(g));(4) a payment made by a principal to an agent as compensation for the services of the agent under a personal services and management contract that meets the requirements of section 1001.952(d) of title 42, Code of Federal Regulations, as in effect on the date of enactment of this section;(5) a waiver or discount (as defined in section 1001.952(h)(5) of title 42, Code of Federal Regulations, or any successor regulation) of any coinsurance or copayment by a health care benefit program if—(A) the waiver or discount is not routinely provided; and(B) the waiver or discount is provided in good faith;(6) a remuneration described in section 1128B(b)(3)(I) of the Social Security Act (42 U.S.C. 1320a–7b(b)(3)(I));(7) a remuneration made pursuant to an alternative payment model (as defined in section 1833(z)(3)(C) of the Social Security Act) or pursuant to a payment arrangement used by a State, health insurance issuer, or group health plan if the Secretary of Health and Human Services has determined that such arrangement is necessary for care coordination or value-based care; or(8) any other payment, remuneration, discount, or reduction as determined by the Attorney General, in consultation with the Secretary of Health and Human Services, by regulation.(c)Regulations.—The Attorney General, in consultation with the Secretary of Health and Human Services, may promulgate regulations to clarify the exceptions described in subsection (b).(d)Preemption.—(1)Federal law.—This section shall not apply to conduct that is prohibited under section 1128B of the Social Security Act (42 U.S.C. 1320a–7b).(2)State law.—Nothing in this section shall be construed to occupy the field in which any provisions of this section operate to the exclusion of State laws on the same subject matter.(e)Definitions.—In this section—(1) the terms “applicable beneficiary” and “applicable drug” have the meanings given those terms in section 1860D–14A(g) of the Social Security Act (42 U.S.C. 1395w–114a(g));(2) the term “clinical treatment facility” means a medical setting, other than a hospital, that provides detoxification, risk reduction, outpatient treatment and care, residential treatment, or rehabilitation for substance use, pursuant to licensure or certification under State law;(3) the term “health care benefit program” has the meaning given the term in section 24(b);(4) the term “laboratory” has the meaning given the term in section 353 of the Public Health Service Act (42 U.S.C. 263a); and(5) the term “recovery home” means a shared living environment that is, or purports to be, free from alcohol and illicit drug use and centered on peer support and connection to services that promote sustained recovery from substance use disorders.(Added Pub. L. 115–271, title VIII, § 8122(a), Oct. 24, 2018, 132 Stat. 4108.)Editorial NotesReferences in Text

The date of enactment of this section, referred to in subsec. (b)(4), is the date of enactment of Pub. L. 115–271, which was approved Oct. 24, 2018.

Section 1833(z)(3)(C) of the Social Security Act, referred to in subsec. (b)(7), is classified to section 1395l(z)(3)(C) of Title 42, The Public Health and Welfare.

Prior Provisions

A prior section 220 was renumbered section 215.

Notes of Decisions
Cited in 19 cases (13 in the last 5 years), 1956–2025 · leading case: Zyla Life Sciences v. Wells Pharma, 134 F.4th 326 (5th Cir. 2025).
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Zyla Life Sciences v. Wells Pharma, 134 F.4th 326 (5th Cir. 2025). · cites it 2× “for referring a resident to a treatment program” unless such conduct is permitted under 18 U.S.C. § 220 and conversely barring any conduct which violates 18 U.”
Guy D. Schooler v. United States, 231 F.2d 560 (8th Cir. 1956). · cites it 5× “Appellant appeals from a judgment based on a jury verdict of guilt on five counts of an indictment charging viola *561 tion of 18 U.S.C. § 220 . 1 ******Reversal is sought solely on the ground that the trial court erred in overruling the motion for judgment of acquittal.”
John Alexander Ryan v. United States, 278 F.2d 836 (9th Cir. 1960). · cites it 2× “Appellant was convicted on six counts of a twenty-one count information, charging him with violation of 18 U.S. C.A. § 220. During the period in question, appellant was an officer and supervisor of the Real Estate Loan Development Administration of Bank of America National Trust…”
United States v. Gerken, 182 F. Supp. 738 (E.D.N.Y 1960). · cites it 5× “This is a case of first impression in which the defendant moves to dismiss the one-count indictment which charges him with a violation of 18 U.S.C. § 220 as follows: The Grand Jury Charges: That on or about the 24th day of April 1957, within the Eastern District of New York, the…”
United States v. John Mentesana, 305 F.2d 214 (2d Cir. 1962). “§ 656 ; counts five and six charged that Mentesana and Gersh induced Blaustein to cash the counterfeit coupons in violation of 18 U.S.C. § 220 ; and count seven charged that the three defendants conspired in violation of 18.”
United States v. Sober, 281 F.2d 244 (3rd Cir. 1960). · cites it 2× “The indictments charged violations of 18 U.S.C. § 220 which forbids receipt by bank officials and employees of gifts or commissions for procuring bank loans; 18 U.”
United States v. Schoenhut, 432 F. Supp. 470 (E.D. Pa. 1977). · cites it 2× “738 , wherein the United States District Court for the Eastern District of New York, in 1960 construed 18 U.S.C. § 220 which was the predecessor of 18 U.”
Gf Indus. of Missouri, LLC v. Lehigh Valley Genomics, LLC (E.D. Pa. 2024). · cites it 10× “, 2022); 18 U.S.C. § 220 . We begin our analysis with the Federal Rules of Civil Procedure.”
United States v. Schena, 142 F.4th 1217 (9th Cir. 2025). · cites it 13× “” 18 U.S.C. § 220 (a)(2)(A). The panel interpreted this 2018 law for the first time, as to a laboratory operator who made payments to marketing intermediaries to induce referrals for medically dubious allergy tests.”
Alpha Genomix Labs., Inc. v. Shane Crandall (Ga. Ct. App. 2023). · cites it 3× “efits under the employment contract; ConGen did not assume liability for breach of the employment contract when it acquired all of Alpha’s shares; Crandall was barred from bringing suit under a contractual indemnification provision; and the severance provision of the employment…”
Zyla Life Sciences v. Wells Pharma. (5th Cir. 2025). · cites it 2× “for referring a resident to a treatment program” unless such conduct is permitted under 18 U.S.C. § 220 and conversely barring any conduct which violates 18 U.”
S&G Labs Hawaii, LLC v. Graves (D. Haw. 2021). “at 4 (some citations omitted) (citing 18 U.S.C. § 220 (a)).] -in March or April 2019, Dr.”
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