Soccer. Healthcare. Kickbacks.
Flash back to May 2015, when federal prosecutors unsealed a 47-count indictment against FIFA officials and marketing executives who had spent the better part of two decades selling something they controlled: media and marketing rights to international soccer, and, allegedly, their votes on where the World Cup would be played. Over a dozen guilty pleas/convictions were obtained.
Prosecutors put the total bribes and kickbacks at north of $150 million, and nobody involved was confused about what it was. The funds moved through shell companies and offshore accounts, but the mechanism itself was not complicated: somebody controlled something valuable, and somebody else paid for access to it.
Sound familiar?
You probably don’t have a World Cup vote to sell. But you have something FIFA executives could only dream of: a referral pad, an OR schedule, a standing order for a lab panel. Different asset, same mechanism, and a similar, i.e., the Anti-Kickback Statute (AKS), and, in some cases, the same, i.e., the Travel Act, Wire Fraud, etc., statutory regime that eventually caught up with FIFA’s frenemies.
What FIFA Fraud and Speaking Fees Have in Common
The AKS doesn’t ask what you called the payment. It asks what the payment bought.
FIFA’s bribes arrived as consulting fees, marketing rights payments, and “loans” that were never repaid. Healthcare’s version arrives in guises such as speaker honoraria, medical directorships, EHR subsidies, “cost deferral” payments, and specimen collection fees that run comfortably above fair market value.
For example, in April 2025, Gilead paid $202 million to resolve allegations that it used speaker fees and travel expenses to move HIV prescriptions. Months earlier, Pfizer’s Biohaven unit paid nearly $60 million for the same basic play with a migraine drug: honoraria and lavish meals functioning as payment for scripts.
Different products, identical structure to what got FIFA’s marketing executives indicted: money moves toward whoever controls the referral, labeled as something else.
The Lab Version
Physicians get caught running this same play with labs, usually without even considering that they’re running it.
In March 2025, three physicians in South Carolina and North Carolina, along with a marketer and his company, paid a combined $1.9 million to settle allegations that a South Carolina lab had been paying them for referrals disguised as “office space rental,” phlebotomy fees, and toxicology payments, and paying the marketer commissions scaled directly to the volume of referrals he arranged.
Strip away the invoice descriptions and it’s a similar bribery pattern with a paper justification bolted on afterward.
The Health System Version
In May 2025, the DOJ announced that Community Health System and its affiliate Physician Network Advantage Inc. (PNA), based in and around Fresno, California, agreed to pay $31.5 million to the United States to resolve civil allegations that they violated the False Claims Act based on financial benefits (that is, kickbacks) provided to referring physicians.
The government alleged that Community Health and PNA provided extravagant benefits to induce physicians in the Fresno area to refer their patients to Community facilities for medical services. PNA is a health care technology business formed and funded by Community to support Fresno-area physicians’ adoption of the electronic health records platform used by Community.
The government alleged that PNA played a key role. In a custom-built lounge located on premises at PNA’s offices, PNA provided expensive wine, liquor, cigars, and meals to referring physicians, with the knowledge and funding of Community.
The settlement also resolved allegations that Community and PNA provided financial subsidies for electronic health records technology and equipment used by physicians in their private offices in return for the referral of governmental health care program patients to Community, as well as allegations that Community paid bonuses to physicians ostensibly for participation in clinical integration activities, when the real purpose of the bonuses was to reward referrals.
Some Timely Takeaways for You
- Name the arrangement by what it does, not what it’s called. If payment moves with referral volume, the label on the agreement is decoration.
- Whether it’s paying to play (e.g., pre- and post-op staffing help demanded of an anesthesia group), or being paid to play (e.g., free or under market equity in a related venture), immediately pause and get qualified counsel.
- If it seems too good to be true, it is. No lab company gives you a McLaren GTS, or even a Chevrolet Malibu, because you’re a swell guy.
- Fair market value is a floor, not an immunity. Even a properly benchmarked payment can violate the AKS if inducing referrals is one purpose of the arrangement.
- Put substance behind every directorship and consulting agreement on your books. Actual duties, actual time logs, actual work product. A monthly check with nothing behind it is a monthly check with nothing behind it.
FIFA’s officials wore committee credentials, not orange jumpsuits, right up until somebody asked what the money was actually for. Ask that question about your own referral relationships before the government asks it for you.
