Rides for Addiction Treatment Centers in 2027: The Eliminating Kickbacks in Recovery Act and Who Pays

What the Eliminating Kickbacks in Recovery Act says

Addiction treatment centers buy rides: intake trips for new clients, discharge rides home, and trips to outside doctor and court appointments. Some also offer a ride company money for every client it brings in. The Eliminating Kickbacks in Recovery Act (EKRA) is the federal law that makes that second offer a crime. Congress added it in October 2018 (Pub. L. 115-271, section 8122) as part of a law aimed at the opioid crisis, and it sits at 18 U.S.C. 220.

The law covers anyone who knowingly and willfully does either of these, for services covered by a health care benefit program:

• Takes payment for referrals. Asks for or accepts anything of value, including a kickback, bribe, or rebate, in cash or in kind, for referring a patient to a recovery home, clinical treatment facility, or laboratory.
• Pays for referrals. Pays or offers anything of value to get someone referred to one of those places, or in exchange for a person using its services.

The words are defined in the statute:

• Clinical treatment facility. A medical setting, other than a hospital, that provides detoxification, risk reduction, outpatient treatment and care, residential treatment, or rehabilitation for substance use under a state license or certification.
• Recovery home. A shared living environment that is, or claims to be, free of alcohol and illicit drugs, centered on peer support and connection to recovery services. This is what most people call a sober home.
• Health care benefit program. Any public or private plan or contract, affecting commerce, under which a medical benefit is provided (18 U.S.C. 24(b)). Private health insurance counts.

The penalty is a fine of up to $200,000, up to 10 years in prison, or both, for each occurrence. EKRA does not apply to conduct the federal anti-kickback statute already prohibits, so when Medicaid or Medicare pays, that statute governs instead. The anti-kickback guide covers it. EKRA also leaves state laws in force.

The exceptions, and the one that is missing

Subsection (b) lists eight exceptions. The ones a small company might meet are properly disclosed discounts, pay to a real employee or contractor that does not vary with the number of people referred or the amounts billed, payments under a personal services contract that meets 42 CFR 1001.952(d) as it read on October 24, 2018, and occasional good-faith copay waivers. The rest cover drug discounts, health centers, approved payment models, and anything the Attorney General adds by regulation. No exception covers transportation.

What EKRA means for a ride company

A ride company can land inside EKRA from either side. You can be paid for bringing clients in, or you can pay others to send clients to the center you drive for.

Walk away from any of these:

• A fee that appears only when the rider is admitted. Per-admission pay, a bonus for each client who checks in, or a share of what the center bills.
• Pay that rises with the client’s insurance or length of stay. That ties your money to the value of the referral, not the ride.
• Being asked to find clients. Recruiting people, running the center’s intake line, or picking up people the center has never spoken to.
• Drop-offs that are not at the center. A request to leave a client at a motel or someone’s house instead of the facility on the order.
• Gifts for you or your drivers. Cash, gift cards, free rent, or meals from a center, a sober home, or a recruiter.

A real case shows how sham paperwork fails. On March 21, 2025, the owner of two Orange County, California treatment centers was sentenced to 41 months and fined $240,000 under EKRA. He paid almost $2.9 million to brokers who supplied patients, and some brokered patients were dropped at motels. His contracts with the brokers said fixed payments and banned pay based on referrals. In practice, the parties set payments by each patient’s insurance and the number of days the center could bill.

Watch your own payroll too. The employee exception covers only pay that does not vary with the number of people referred, so pay drivers and dispatchers by the hour or the trip, never by admissions.

Florida’s patient brokering and marketing laws

Florida adds three laws that reach further than EKRA.

• Patient brokering, section 817.505. No person may pay or accept a commission, benefit, bonus, rebate, kickback, bribe, or split fee to induce a referral to or from a health care provider or facility, or in return for someone accepting treatment there. It applies whoever pays. The covered providers include substance abuse providers licensed under chapter 397 and anyone contracted with the state to serve Medicaid recipients, so a ride company enrolled with Florida Medicaid is itself a covered provider, and paying anyone to send riders to your company is covered too. It is a third-degree felony with a $50,000 fine, rising when 10 or more patients are involved. The law exempts practices the federal anti-kickback statute allows. It also exempts some free referral services, but only if they never provide or arrange transportation.
• Deceptive marketing, section 397.55. Treatment providers, recovery residence operators, and any third party that advertises or markets for them may not give false or misleading information about services or locations, or use websites that quietly redirect readers. A ride company that advertises for a center is one of those third parties.
• Recovery residence referrals, section 397.4873. With narrow exceptions, a licensed provider may refer patients to, or accept them from, only a certified recovery residence run by a certified administrator. Simply telling a patient a residence’s name or address counts as a referral. A provider faces a $1,000 administrative fine per occurrence.

For you, that means discharge rides go only to the address the center or the rider gives in writing, and drivers never suggest a center or a sober home to anyone. The Florida state guide covers licensing and Medicaid enrollment there.

Rider privacy: 42 CFR part 2 and the February 16, 2026 deadline

A pickup list from most treatment centers is a protected record. Federal rule 42 CFR part 2 protects records that identify a person as a patient of a federally assisted substance use program, and a name and address count. A program is federally assisted if, for example, it takes part in Medicare, holds federal authorization for maintenance or withdrawal treatment, is registered to dispense controlled substances for addiction treatment, or receives federal funds in any form (42 CFR 2.12(b)).

Part 2 gives a center a clean way to send you what you need. A program may share information with a qualified service organization without each patient’s consent, limited to what that organization needs to serve the program (42 CFR 2.12(c)(4)). To qualify, your company signs a written agreement with the program that does two things (42 CFR 2.11):

1. Says you are fully bound by part 2 when you receive, store, or handle any of its patient records.
2. Promises that, if necessary, you will resist court efforts to get the records, except as part 2 allows.

If the center is also a HIPAA covered entity, a business associate counts as a qualified service organization for records that are also protected health information.

The rules changed recently. HHS rewrote part 2 in a final rule published February 16, 2024 (89 FR 12472), effective April 16, 2024, and everyone covered had to comply by February 16, 2026. Part 2 violations now carry HIPAA’s civil and criminal penalties. The methadone rides guide covers the redisclosure notice and day-to-day privacy on treatment trips, and HIPAA for NEMT covers the rest.

Safety on intake, discharge, and outside appointment rides

Intake riders may be in withdrawal. MedlinePlus (reviewed January 1, 2025) says alcohol withdrawal can quickly become life-threatening, and to call 911 or go to an emergency room if seizures, fever, severe confusion, hallucinations, or an irregular heartbeat occur. Train drivers to treat those signs as an emergency, and use the steps in medical emergency during a ride, including what to do for a possible overdose.

A rider who needs medical monitoring on the way belongs in an ambulance, not a van. See NEMT vs ambulance. A rider in crisis who may harm themselves or others needs secure transport, which some states license separately, and a regular driver never restrains anyone. See behavioral health transportation.

Put the ride rules in your agreement with the center so nobody improvises:

• Hand-offs. Who meets the rider at pickup and at the door of the facility.
• Belongings. What the center allows riders to bring, and who checks bags. Your driver does not search riders.
• Stops. No stops that are not on the order, including stores and restaurants.
• A rider who wants out. The driver pulls over somewhere safe and public, then calls dispatch and the center.
• Riders who need company. Whether staff or a family member rides along with a minor or a high-risk rider.

Who pays for rides to addiction treatment

Four payers buy these rides, and each one is clean when you are paid for the ride and nothing else.

• Medicaid. States must ensure necessary transportation to and from providers (42 CFR 431.53), and medication-assisted treatment for opioid use disorder, including methadone, counseling, and behavioral therapy, has been Medicaid medical assistance since October 1, 2020, unless a state certifies a provider shortage. Those trips come through your state’s NEMT program or broker at its rates. The methadone rides guide covers the daily opioid treatment program trips.
• The treatment center. A center pays you directly under a signed agreement, priced per trip, mile, or hour, the same as a facility contract with a hospital.
• Families. A parent or spouse books and pays for an intake or discharge ride. Quote the total before the ride and take payment as you would for any private pay ride, priced from your costs with the method in how much to charge for NEMT.
• County and state programs. The 2022 national settlement with opioid distributors lists approved uses in Exhibit E, and Schedule B names providing or supporting transportation to treatment or recovery programs for people with opioid use disorder. SAMHSA’s State Opioid Response grants (notice TI-24-008, the current round as of October 2026), which go to each state’s substance use agency for a project period of up to three years from an anticipated start of September 30, 2024, list transportation among recovery support services. They also fund rural ride programs, including vouchers that riders hand to participating transportation providers. The grants may not pay individuals to enter treatment.

Some centers bring in clients from other states. A paid trip across a state line brings federal carrier rules, so read USDOT numbers for NEMT first. Then price it with long-distance medical transport cost, and charge the same whether or not the client is admitted at the end of the drive.

How to set up a clean treatment center agreement

1. Put it in writing first. A signed agreement, before the first ride, listing every service you provide.
2. Price the ride, not the client. A rate per trip, loaded mile, and wait hour, the same for every rider, whether admitted or not. No bonuses and no share of what the center bills.
3. Use the safest shape for a flat fee. If the center wants a monthly fee, follow the personal services exception EKRA borrows: a term of at least one year, a schedule and exact charge for part-time service, and a total set in advance at fair market value that does not depend on referrals (42 CFR 1001.952(d), as of October 24, 2018).
4. Only drive. Do not market, recruit, screen, or answer intake calls for the center.
5. Bill rides you gave. Invoice from your trip logs, and keep the logs and the agreement.
6. Sign a qualified service organization agreement before the center sends patient names, and limit who in your office can see them.
7. Train drivers. No recommending centers or sober homes, no gifts, and every offer of money for clients reported to you in writing.
8. Have a health care lawyer read the agreement, especially in Florida, where state law reaches every payer.