§ 1005. Kickback schemes and solicitation.
495 words·~2 min read·
/de/title-31/chapter-10-fraudulent-acts/1005·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)It shall be unlawful for any person to solicit or receive any remuneration (including kickback, bribe or rebate) directly or indirectly, overtly or covertly, in cash or in kind:
(1)In return for referring an individual to a provider for the furnishing or arranging for the furnishing of any medical care or medical assistance for which payment may be made in whole or in part under any public assistance program; or
(2)In return for purchasing, leasing, ordering or arranging for or recommending purchasing, leasing, or ordering any property, facility, service or item of medical care or medical assistance for which payment may be made in whole or in part under any public assistance program.
(b)It shall be unlawful for any person to offer or pay any remuneration (including any kickback, bribe or rebate) directly or indirectly, in cash or in kind to induce any other person:
(1)To refer an individual to a provider for the furnishing or arranging for the furnishing of any medical care or medical assistance for which payment may be made in whole or in part under any public assistance program; or
(2)To purchase, lease, order or arrange for or recommend purchasing, leasing or ordering any property, facility, service, or item of medical care or medical assistance for which payment may be made in whole or in part under any public assistance program.
(c)It shall be unlawful for any provider to:
(1)Charge, solicit, accept or receive for any service provided to a recipient, money or other consideration in addition to or at a rate in excess of the rates established by the State for such item or service; or
(2)Charge, solicit or receive, in addition to any amount otherwise required to be paid by the State, any gift, money, donation, or other consideration (other than a charitable, religious or philanthropic contribution from an organization or from a person unrelated to the patient) as a precondition to admitting a patient to a hospital, skilled nursing facility or intermediate care facility, or as a requirement for the patient’s continued stay in such a facility, when the cost of services provided therein to the patient is paid for, in whole or in part, by the State.
(d)Subsections (a),
(b)and
(c)of this section shall not apply to:
(1)A discount or other reduction to price obtained by a provider under this chapter if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider; or
(2)Wages paid by an employer to an employee as part of a bona fide employment relationship; or
(3)Contracts between the State and a public or private agency where part of the agency’s responsibility is referral of a person to a provider;
(4)Dividends based exclusively on a legitimate ownership interest;
(5)Fees for services actually rendered, provided that the fees are not made to induce referrals to the provider.