West Virginia Code § 16-62-3

Exceptions
Open in Lexace · Ask the AI about this section
This article does not apply to the following payment practices:
(1) Any discount, payment, waiver of payment, or payment practice expressly authorized by
42 U.S.C. §1320a-7b(b)(3) or regulations adopted thereunder;
(2) Any payment, compensation, or financial arrangement within a group practice provided
the payment, compensation, or arrangement is not to or from persons who are not members
of the group practice;
(3) Payments to a health care provider or health care facility for professional consultation
services;
(4) Commissions, fees, or other remuneration lawfully apaid to insurance agents;
(5) Payments by a health insurer who reimburses, provides, offers to provide, or administers
health, mental health, or substance abuse goods or services under a health benefit plan;
(6) Payments to or by a health care provider or health care facility, or a health care provider
network entity, that has contracted with a health insurer, a health care purchasing group, or
the Medicare or Medicaid program to provide health, mental health, or substance abuse
goods or services under a health benefit plan when the payments are for goods or services
under the plan;
(7) Insurance advertisinLg and promotional gifts;
(8) Commissions or fees paid to a person or entity providing a referral service to nurses
which provide health care services;
(9) Payments by a health care provider or health care facility to a health, mental health, or
subWstance abuse information service that provides information upon request and without
charge to consumers about providers of health care goods or services to enable consumers
to select appropriate providers or facilities, provided that the information service:
(A) Does not attempt through its standard questions for solicitation of consumer criteria or
through any other means to steer or lead a consumer to select or consider selection of a
particular health care provider or health care facility;
(B) Does not provide or represent itself as providing diagnostic or counseling services or
assessments of illness or injury and does not make any promises of cure or guarantees of
treatment;
(C) Does not provide or arrange for transportation of a consumer to or from the location of a
health care provider or health care facility; and
(D) Charges and collects fees from a health care provider or health care facility participating
in its services that are set in advance, are consistent with the fair market value for those
information services, and are not based on the potential value of a patient or patients to a
health care provider or health care facility or of the goods or services provided by the health
care provider or health care facility.
(10) Payments made by an assisted living facility to an individual employed eby the assisted
living facility, or with whom the facility contracts to provide marketing services for the
facility, if the individual clearly indicates that he or she works with or fror the facility; and
(11) Payments made to a resident of an assisted living facility whuo refers a friend, family
members, or other individuals with whom the resident has a personal relationship to the
assisted living facility, in which case the assisted living facilitty may provide a monetary
reward to the resident for making the referral.

‹ Prev All West Virginia 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.