Purpose

ABAS receives new client leads through word of mouth, internet search, recommendations, and relationships with families, schools, early intervention programs, pediatric practices, and other community providers, and its services are funded primarily by public healthcare programs, principally MassHealth. This policy prohibits offering, paying, soliciting, or receiving anything of value to induce or reward referrals, and it sets the rules for gifts, marketing, and vendor relationships so that every referral to or from ABAS is based solely on the member's clinical needs. It exists to keep ABAS compliant with the federal Anti-Kickback Statute and the Massachusetts kickback prohibition, both of which carry criminal penalties and can exclude a provider from MassHealth.

Scope

This policy applies to all ABAS employees, including the Executive Director, Director of Operations, BCBA Team, Behavior Technician Team, Billing & Recovery Specialist, Employee Relations Specialist, and Compliance Officer. It governs any arrangement in which ABAS or an employee gives or receives anything of value involving a referral source, prospective referral source, vendor, or other provider, including gifts, business courtesies, marketing and outreach activities, and contracted services. It applies whether the underlying services are payable by MassHealth or by another payer, because Massachusetts law extends the kickback prohibition beyond federal healthcare programs.

Definitions

Policy Statement

5.1 Prohibition

ABAS prohibits offering, paying, soliciting, or receiving any remuneration, directly or indirectly, to induce or reward the referral of members or other business payable by MassHealth or any other payer. This standard reflects the federal Anti-Kickback Statute (42 U.S.C. § 1320a-7b) and the Massachusetts kickback prohibition (M.G.L. c. 175H, § 3). Under the federal statute, an arrangement is unlawful if even one purpose of the remuneration is to induce referrals, regardless of how the arrangement is labeled or documented.

5.2 Gifts and Business Courtesies

Employees must not give gifts or business courtesies to referral sources, and must not accept them from referral sources, vendors, or client families, beyond items of nominal value. Cash and cash equivalents, including gift cards, are prohibited in any amount and in either direction. The nominal-value limits, and the requirement to ask the Compliance Officer before giving or accepting anything of value involving a referral source or vendor, are set in STD-001 (Gift and Courtesy Standard). A gift that arrives unsolicited and exceeds the limit must be declined or returned, and the offer reported to the Compliance Officer.

5.3 Referral Arrangements

ABAS does not pay for referrals and does not accept payment for referring members to other providers. No agreement, written or verbal, may condition anything of value on the volume or value of referrals between the parties. Referrals ABAS makes to outside providers must be based solely on the member's clinical needs, and the BCBA Team must be able to support each referral on clinical grounds alone.

5.4 Marketing and Outreach

ABAS marketing and community outreach must be truthful and must describe services accurately. ABAS does not offer members, families, or prospective members money, gifts, free goods, or other inducements to choose ABAS, remain with ABAS, or accept additional services. Outreach to referral sources is limited to providing accurate information about ABAS services and availability; it may not include payments, gifts beyond nominal value, or promises of reciprocal referrals. All marketing and outreach activity is conducted under the direction of the Executive Director.

5.5 Vendor and Contractor Relationships

Every arrangement in which ABAS pays a vendor, contractor, or other provider that is also an actual or potential referral source must be in writing, reflect fair market value, serve a documented and legitimate business need, and not vary with referrals between the parties. The Compliance Officer must review any such arrangement before ABAS signs it and, where possible, the arrangement must be structured to satisfy an applicable federal safe harbor. Existing arrangements that do not meet these requirements must be reported to the Compliance Officer for correction or termination.

5.6 Relationship to False Claims Liability

A claim that results from a kickback is a false claim. A violation of this policy can therefore expose ABAS to liability under the federal False Claims Act and the Massachusetts False Claims Act, to repayment obligations, and to exclusion from MassHealth under its provider regulations. Employees must bring any proposed arrangement involving a referral source to the Compliance Officer before ABAS enters into it; asking first is always acceptable, and entering an arrangement without review is not.

Procedures

Responsibilities

Steps

1. Before ABAS enters any arrangement that involves payment or anything of value moving between ABAS and a referral source or vendor, the employee proposing it sends the terms to the Compliance Officer for review.
2. The Compliance Officer reviews the arrangement against this policy, including fair market value, business need, and available safe harbors, and documents the conclusion.
3. The Executive Director signs approved arrangements; the Director of Operations stores the written agreement.
4. An employee who is offered, or asked to provide, anything of value connected to referrals declines and reports the contact to the Compliance Officer through the channels in POL-003.
5. The Compliance Officer reviews active vendor and referral-source arrangements annually as part of the compliance work plan and reports the results to the Compliance Committee.

Training Requirements

All ABAS employees must complete training on this policy during onboarding and at least annually thereafter as part of compliance refresher training. Employees who negotiate or manage vendor, contractor, or referral-source relationships (the Executive Director, Director of Operations, and Compliance Officer) and the BCBA Team must complete role-specific training covering the Anti-Kickback Statute, the Massachusetts kickback prohibition, and the federal safe harbors, consistent with OIG compliance program guidance. The Compliance Officer tracks completion and reports completion rates to the Compliance Committee as part of regular compliance reporting.

Reporting and Enforcement

Employees who suspect a kickback, an improper referral arrangement, or any other violation of this policy must report it through the channels described in POL-003 (Compliance Reporting, Investigation, and Resolution), including the anonymous web form and the compliance ticketing system. Reports are investigated under POL-003 and its Compliance Ticket Management SOP. A confirmed violation may result in corrective action up to and including termination, unwinding or termination of the arrangement involved, repayment of any improper amounts, and referral to MassHealth, law enforcement, or other authorities where required by law. Because the Anti-Kickback Statute is a criminal statute, ABAS treats confirmed violations as serious matters requiring Executive Director and Compliance Committee involvement. ABAS will not retaliate against any person who reports a concern in good faith.

Forms Reference

The register supporting this policy is maintained by the Director of Operations:

Every vendor and referral-source arrangement is recorded in the Vendor & Contract Arrangements Register (REG-002), including the Compliance Officer's review date and conclusion, the fair-market-value basis and documented business need, the written-agreement reference, and the Executive Director's signature. The Compliance Officer uses the register for the annual review of active arrangements (Section Procedures, Step 5). REG-002 also serves POL-011 (Exclusion Checks).