North Carolina General Statutes 90-407. Disciplinary action and penalties
(a) Any violation of this Article shall constitute grounds for disciplinary action to be taken by the applicable Board pursuant to Chapter 90 of the N.C. Gen. Stat..
(b) Any health care provider who refers a patient in violation of N.C. Gen. Stat. § 90-406(a), or any health care provider or entity who
(1) Presents or causes to be presented a bill or claim for service that the health care provider or entity knows or should know is prohibited by N.C. Gen. Stat. § 90-406(b), or
Terms Used In North Carolina General Statutes 90-407
- Board: means any of the following boards created in Chapter 90 of this Article relating respectively to the professions of medicine, dentistry, optometry, osteopathy, chiropractic, nursing, podiatry, psychology, physical therapy, occupational therapy, speech and language pathology and audiology. See North Carolina General Statutes 90-405
- Designated health care services: means , and includes for purposes of this section, any health care procedure and service provided by a health care provider that is covered by or insured under any health benefit plan regulated by Chapter 58 of the N. See North Carolina General Statutes 90-405
- Entity: means any individual, partnership, firm, corporation, or other business that provides health care services. See North Carolina General Statutes 90-405
- Health care provider: is a ny person who, pursuant to Chapter 90 of the N. See North Carolina General Statutes 90-405
- in writing: may be construed to include printing, engraving, lithographing, and any other mode of representing words and letters: Provided, that in all cases where a written signature is required by law, the same shall be in a proper handwriting, or in a proper mark. See North Carolina General Statutes 12-3
- state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories, so called; and the words "United States" shall be construed to include the said district and territories and all dependencies. See North Carolina General Statutes 12-3
(2) Fails to make a refund as required by N.C. Gen. Stat. § 90-406(c),
shall be subject to a civil penalty of not more than twenty thousand dollars ($20,000) for each such bill or claim, to be recovered in an action instituted either in Wake County Superior Court, or any other county, by the Attorney General for the use of the State of North Carolina.
(c) Any health care provider or other entity that enters into an arrangement or scheme, such as cross-referral arrangement, that the health care provider or entity knows or should know is intended to induce referrals or patients for designated health care services to a particular entity and that, if the health care provider directly made referrals to such entity, would violate N.C. Gen. Stat. § 90-406(d), shall be subject to a civil penalty of not more than seventy-five thousand dollars ($75,000) for each such circumvention arrangement or scheme, to be recovered in an action instituted either in Wake County Superior Court, or any other county, by the Attorney General for the use of the State of North Carolina. No civil penalty shall be assessed hereunder for any arrangement fully disclosed to the Attorney General in writing which receives a favorable determination by the Attorney General that, in his opinion, such arrangement is not a violation of N.C. Gen. Stat. § 90-406, until a contrary determination is made in a court of law.
(d) The clear proceeds of civil penalties provided for in this section shall be remitted to the Civil Penalty and Forfeiture Fund in accordance with N.C. Gen. Stat. § 115C-457.2 (1993, c. 482, s. 1; 1998-215, s. 74.)