State Codes and Statutes

State Codes and Statutes

Statutes > North-carolina > Chapter_90 > GS_90-405

Article 28.

Self‑Referrals by Health Care Providers.

§ 90‑405.  Definitions.

As used in this Article, the term

(1)        "Board" means any of the following boards createdin Chapter 90 of this Article relating respectively to the professions ofmedicine, dentistry, optometry, osteopathy, chiropractic, nursing, podiatry,psychology, physical therapy, occupational therapy, speech and languagepathology and audiology.

(2)        "Department" means the Department of Health andHuman Services of the State of North Carolina.

(3)        "Designated health care services" means, andincludes for purposes of this section, any health care procedure and serviceprovided by a health care provider that is covered by or insured under anyhealth benefit plan regulated by Chapter 58 of the General Statutes, anyemployee welfare benefit plan regulated by the Employee Retirement IncomeSecurity Act of 1974, any federal or State employee insurance program, Medicareor Medicaid.

(4)        "Entity" means any individual, partnership, firm,corporation, or other business that provides health care services.

(5)        "Fair market value" means the value of the rentalproperty for commercial purposes not adjusted to reflect the additional valuethat one party (either the prospective lessee or lessor) would attribute to theproperty as a result of its proximity or convenience to sources of referrals orbusiness.

(6)        "Group practice" means a group of two or morehealth care providers legally organized as a partnership, professionalcorporation, or similar association:

a.         In which each health care provider who is a member of thegroup provides services including consultation, diagnosis, or treatment,through the joint use of shared facilities, equipment, and personnel;

b.         For which substantially all the services of the health careproviders who are members of the group are provided through the group and arebilled in the name of the group and amounts so received are treated as receiptsof the group; and

c.         In which the overhead expenses of and the income from thepractice are distributed in accordance with methods previously determined bymembers of the group.

(7)        "Health care provider" is any person who, pursuantto Chapter 90 of the General Statutes, is licensed, or is otherwise registeredor certified to engage in the practice of any of the following: medicine,dentistry, optometry, osteopathy, chiropractic, nursing, podiatry, psychology,physical therapy, occupational therapy or speech and language pathology andaudiology.

(8)        "Immediate family member" means a health careprovider's spouse or dependent minor child.

(9)        "Investment interest" means an equity or debtsecurity issued by an entity, or a lease or retained interest in real propertyheld by an entity, including, without limitation, shares of stock in acorporation, units or other interests in a partnership, bonds, debentures,notes, leases, options or contracts related to real property or other equityinterests or debt instruments. "Investment interest" and legal orbeneficial interest shall not include any interest in:

a.         Bonds or other debt instruments issued pursuant to theprovisions of Chapter 159 of the General Statutes;

b.         A written lease of real property entered into on or beforeJanuary 1, 1990, for a term of five years or more or a written lease of real propertyfor a term of one year or more, which fully describes the leased premises, theterms and conditions for the lease thereof, with the aggregate rental charge,set in advance, consistent with fair market value in arms‑lengthtransactions and not determined in a manner that takes into account the volumeor value of any referrals or business otherwise generated between the partiesto the lease;

c.         An employee's stock purchase, savings, pension, profitsharing or other similar benefit plan in which the investor does not directinvestments;

d.         Investment interests (including shares of stock, bonds,debentures, notes or other debt instruments) in any corporation that is listedfor trading on the New York Stock Exchange, the American Stock Exchange, or isa national market system security traded under automated interdealer quotationsystem operated by the National Association of Securities Dealers and has, atthe end of the corporation's most recent fiscal year, total assets exceedingfifty million dollars ($50,000,000), provided that one of the followingrequirements is satisfied:

1.         The investment interests are purchased in a nonissuertransaction as permitted by G.S. 78A‑17(3); or

2.         The investment interests are issued in a transactionterminating a health care provider's legal, beneficial, or investment interestin a privately held entity which such health care provider acquired beforeApril 1, 1993, provided that such transaction is completed before July 1, 1995,and the health care provider liquidates the investment interests by July 1,1997.

(10)      "Investor" means an individual or entity owning alegal 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).

(11)      "Referral" means any referral of a patient fordesignated health care services, including, without limitation:

a.         The forwarding of a patient by one health care provider toanother health care provider or to an entity that provides any designatedhealth care service; or

b.         The request or establishment of a plan of care by a healthcare provider, which includes the provision of designated health care services.

"Referral" does not mean any designatedhealth care service or any referral to an entity for a designated health careservice which is provided by, or provided under the personal supervision of, asole health care provider or by a member of a group practice to the patients ofthat health care provider or group practice. (1993, c. 482, s. 1; 1995, c. 509, s. 46; 1997‑443, s.11A.118(a).)