(a) For the purpose of this section, the following definitions apply: (1) âFinancial interest in another entityâ means, subject to subdivision (h), either of the following: (A) Any type of ownership, interest, debt, loan, lease, compensation, remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, between the interested party and the other entity that the employee is referred for services. (B) An agreement, debt instrument, or lease or rental agreement between the interested party and the other entity that provides compensation based upon, in whole or in part, the volume or value of the services provided as a result of referrals. (2) âInterested partyâ means any of the following: (A) An injured employee. (B) The employer of an injured employee, and, if the employer is insured, its insurer. (C) A claims administrator, that includes, but is not limited to, a self-administered workersâ compensation insurer, a self-administered self-insured employer, a self-administered joint powers authority, a self-administered legally uninsured employer, a third-party claims administrator for an insurer, a self-insured employer, a joint powers authority, or a legally uninsured employer or a subsidiary of a claims administrator. (D) An attorney-at-law or law firm that is representing or advising an employee regarding a claim for compensation under Division 4 (commencing with Section 3200). (E) A representative or agent of an interested party, including either of the following: (i) An employee of an interested party. (ii) An individual acting on behalf of an interested party, including the immediate family of the interested party or of an employee of the interested party. For purposes of this clause, immediate family includes spouses, children, parents, and spouses of children. (F) A provider of medical services or products. (3) âServicesâ means, but is not limited to, the following: (A) A determination regarding an employeeâs eligibility for compensation under Division 4 (commencing with Section 3200), that includes both of the following: (i) A determination of a permanent disability rating under Section 4660. (ii) An evaluation of an employeeâs future earnings capacity resulting from an occupational injury or illness. (B) Services to review the itemization of medical services set forth on a medical bill submitted under Section 4603.2. (C) Copy and document reproduction services. (D) Interpreter services. (E) Medical services, including the provision of medical products such as surgical hardware or durable medical equipment. (F) Transportation services. (G) Services in connection with utilization review pursuant to Section 4610. (b) (1) All interested parties shall disclose to a third-party payer or other entity to whom a claim for payment is presented for services furnished pursuant to a referral, a financial interest in an entity providing services. (2) The disclosure pursuant to this subdivision shall be made in writing, at the time the claim for payment is presented for services furnished pursuant to a referral. (c) Except as otherwise permitted by law, it is unlawful for an interested party other than a claims administrator or a network service provider to refer a person for services provided by another entity, or to use services provided by another entity, if the other entity will be paid for those services pursuant to Division 4 (commencing with Section 3200) and the interested party has a financial interest in the other entity. (d) (1) It is unlawful for an interested party to enter into an arrangement or scheme, such as a cross-referral arrangement, that the interested party knows, or should know, has a purpose of ensuring referrals by the interested party to a particular entity that, if the interested party directly made referrals to that other entity, would be in violation of this section. (2) It is unlawful for an interested
‹ Prev All California sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.