North Carolina General Statutes 90-406. Self-referrals prohibited
Terms Used In North Carolina General Statutes 90-406
- 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
- Group practice: means a group of two or more health care providers legally organized as a partnership, professional corporation, or similar association:
- Health care provider: is a ny person who, pursuant to Chapter 90 of the N. See North Carolina General Statutes 90-405
- Investor: means an individual or entity owning a legal or beneficial ownership or investment interest, directly or indirectly (including without limitation, through an immediate family member, trust, affiliate, or another entity related to the investor). See North Carolina General Statutes 90-405
- Referral: means any referral of a patient for designated health care services, including, without limitation:
(a) A health care provider shall not make any referral of any patient to any entity in which the health care provider or group practice or any member of the group practice is an investor.
(b) No invoice or claim for payment shall be presented by any entity or health care provider to any individual, third-party payer, or other entity for designated health care services furnished pursuant to a referral prohibited under this Article.
(c) If any entity collects any amount pursuant to an invoice or claim presented in violation of this section, the entity shall refund such amount to the payor or individual, whichever is applicable, within 10 working days of receipt.
(d) Any health care provider or other entity that enters into an arrangement or scheme, such as a cross-referral arrangement that the health care provider or entity knows or should know is intended to induce referrals of patients for designated health care services to a particular entity and that, if the health care provider directly made referrals to such entity, would constitute a prohibited referral under this section, shall be in violation of this section. (1993, c. 482, s. 1.)