Evidence map›Paper›PMID 42857834›Full record

ArticleOrthopedic reviews2026

Safe Harbors to the Federal Anti-Kickback Statute in Orthopedics: A Rapid Review.

Theodore Couris, Parker Lehmann, Paul Cappiello, Matthew Michelberger, Christopher Fang

Abstract read
In one paragraph

Article in Orthopedic reviews, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Theodore CourisKirk Kerkorian School of Medicine.ORCID https://orcid.org/0009-0004-5387-3275
Parker LehmannKirk Kerkorian School of Medicine.ORCID https://orcid.org/0009-0003-9341-9424
Paul CappielloKirk Kerkorian School of Medicine.ORCID https://orcid.org/0009-0004-8672-1542
Matthew MichelbergerUniversity of Nevada, Las Vegas.ORCID https://orcid.org/0009-0003-6009-1792
Christopher FangDepartment of Orthopaedics Kirk Kerkorian School of Medicine.ORCID https://orcid.org/0000-0002-3367-8876

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction: Orthopedic surgery relies on complex collaborations across ambulatory surgery centers (ASCs), device industries, and value based care models. However, a lack of specialty-specific guidance leaves orthopedic surgeons vulnerable to Federal Anti-Kickback Statute (AKS) violations. This review maps how legal safe harbors apply directly to modern orthopedic business arrangements. Objective: The purpose of this review is to summarize the federal Anti-Kickback Statute safe harbors most relevant to orthopedic practice, clarify how they apply to common orthopedic business arrangements, identify high-risk arrangements in orthopedic practice, and to demonstrate practical compliance strategies. Methods: A rapid review of PubMed, PMC, and Google Scholar was conducted from inception to October 29, 2025. This search was supplemented with official federal materials, Office of Inspector General (OIG) advisory opinions, and Department of Justice (DOJ) enforcement actions to synthesize a narrative compliance framework for orthopedic practice. Results: Out of 123 screened records, 17 sources were used to explore the AKS in terms of orthopedic practice. 18 additional sources were included to supplement this analysis. This study identified gray zones in orthopedics: consulting agreements, royalty arrangements, ASC investment terms, and industry funded travel. High-risk arrangements are often targeted by regulators when compensation is high, as demonstrated by recent multi-million dollar DOJ settlements. Conclusion: AKS safe harbors provide vital protection but demand meticulous, ongoing documentation of compliance. As value-based care expands, orthopedic surgeons must ensure that modern, integrated business models are structured strictly around clinical justification and independent medical judgment, actively insulating patient care from personal financial incentives.

Indexed as

advisory opinionsambulatory surgery centerremunerationsafe harborvalue-based care

Identifiers

PMID42857834
PMCPMC13652545

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.