Patient Brokering, EKRA and Lead Buying: A Marketing Compliance Checklist for Treatment Centers

Addiction treatment has some of the strictest marketing rules of any business, written to stop patient brokering. Several practices that are normal in other industries are crimes here. This checklist covers them. It is general information, not legal advice, so review your own arrangements with counsel.

1. Never pay for patients

EKRA, 18 U.S.C. § 220, makes it a federal crime to pay or receive anything for referring a patient to a recovery home, clinical treatment facility or laboratory, or in exchange for someone using their services, when the services are covered by a health care benefit program. That includes private insurance. Each occurrence carries up to $200,000 and 10 years in prison.

The exception for employees and contractors applies only when pay does not vary with the number of people referred or the amounts billed. That is why per-admission, per-call and per-lead pricing from a marketer is a red flag. Pay for the work: a flat fee, or media and management at set rates. We never charge per admission, per call or per lead.

2. Check your state's brokering law

States add their own. Florida § 817.505 makes patient brokering a felony, with fines up to $500,000 when 20 or more patients are involved, and Arizona § 13-3730 covers sober living homes and treatment enrollment. Laws differ by state, so check the ones where you operate and where you advertise.

3. Don't buy or sell leads

NAATP's code of ethics bars members from buying or selling patient leads, including phone calls, and from owning directory-type websites. LegitScript bars certified providers from lead-generator ties, and you need LegitScript to advertise on Google and Meta. Generate your own inquiries and own them.

4. Never borrow another center's name

In June 2025 the FTC settled with a clinic whose Google ads bid on other clinics' names, carried its own call-center number and had telemarketers pose as a central admissions hotline. The penalty was $7 million, suspended to $1.9 million, with a ban on impersonating other businesses. NAATP also bars search ads that use another center's name in the ad text.

5. Say only what is true

The Opioid Addiction Recovery Fraud Prevention Act makes unfair or deceptive marketing of substance use treatment, including referral services, a violation with civil penalties. The FTC's first case under it, against a referral network that misrepresented how it vetted centers, produced a $3.8 million judgment. Describe your levels of care, licensing, insurance and outcomes exactly as they are. NAATP requires outpatient programs with housing to label themselves clearly.

6. Keep patient data out of ad tools

HHS says tracking technology on logged-in pages generally has access to protected health information, and any vendor receiving it needs a business associate agreement or patient authorization. The updated 42 CFR Part 2 rule for substance use disorder records required compliance by February 16, 2026. Keep pixels off intake forms, portals and booking pages, and measure with call tracking.

7. Mind the geofencing laws

Washington, New York, Connecticut and Nevada restrict geofencing around health care facilities, at 1,750 to 2,000 feet; Connecticut's law covers mental health and sexual or reproductive health facilities. Fencing a competitor's facility, or a hospital, can break those laws. Target places people go before they need care, or use audience targeting instead.

The short checklist

• No pay per admission, call or lead, to anyone.
• No buying or selling leads; no directory you secretly own.
• No other center's name in your ads.
• Every claim on your site and ads is accurate.
• LegitScript certified before you run Google or Meta ads (our guide).
• Pixels kept away from patient information.
• No geofences around health facilities in restricted states.

Marketing that follows these rules can still fill beds. The plan Jarrett designed for one residential center used search, display, email and Meta, every dollar paid at set rates, and admissions-related calls averaged 156% above the starting month.