Louisiana Administrative Code › Title 46 - PROFESSIONAL AND OCCUPATIONAL STANDARDS › Part XLV - Medical Professions › Subpart 3 - Practice › Chapter 42 - Illegal Payments; Required Disclosures of Financial Interests ; Prohibition on Rural Physician Self-Referral › Section XLV-4203 - Definitions and Construction

Current through Register Vol. 50, No. 6, June 20, 2024
A. Definitions. As used in this Chapter:
Board
- the Louisiana State Board of
					 Medical Examiners.
Financial Interest
- a significant
					 ownership or investment interest established through debt, equity, or other
					 means and held, directly or indirectly, by a physician or a member of a
					 physician's immediate family, or any form of direct or indirect remuneration
					 for referral.
Group Practice
- a group of two or more
					 physicians legally organized as a general partnership, registered limited
					 liability partnership, professional medical corporation, limited liability
					 company, foundation, nonprofit corporation, faculty practice plan, or similar
					 organization or association:
a. in which each physician who is a member of the group
					 provides substantially the full range of services which the physician routinely
					 provides, including medical or podiatric care, consultation, diagnosis, or
					 treatment, through the joint use of shared office space, facilities, equipment,
					 and personnel;
b. for which substantially all of the services of the
					 physicians who are members of the group are provided through the group and are
					 billed under a billing number assigned to the group and amounts so received are
					 treated as receipts of the group;
c. in which the overhead expenses of and the income from
					 the practice are distributed in accordance with methods previously
					 determined;
d. in which no physician who is a member of the group
					 directly or indirectly receives compensation based on the volume or value of
					 referrals by the physician, except payment of a share of the overall profits of
					 the group, which may include a productivity bonus based on services personally
					 performed or services incident to such personally performed services, so long
					 as the share of profits or bonus is not determined in any manner which is
					 directly related to the volume or value of referrals by such physician;
e. in which members of the group personally conduct no less
					 than 75 percent of the physician-patient encounters of the group practice;
					 and
f. in the case of a faculty practice plan associated with a
					 hospital, institution of higher education, or medical school with an approved
					 medical residency training program in which physician members may provide a
					 variety of different specialty services and provide professional services both
					 within and outside the group, as well as perform other tasks such as research,
					 solely with respect to services provided within such faculty practice
					 plan.
Health Care Item
- any substance, product,
					 device, equipment, supplies, or other tangible good or article which is or may
					 be used or useful in the provision of health care.
Health Care Provider
- any person licensed
					 by a department, board, commission, or other agency of the state of Louisiana
					 to provide, or which does in fact provide, preventive, diagnostic, or
					 therapeutic health care services or items.
Immediate Family
- as respects a physician,
					 the physician's spouse, children, parents, and siblings.
Investment Interest
- a security issued by
					 an entity, including, without limitation, shares in a corporation, interests in
					 or units of a partnership, bonds, debentures, notes, or other debt
					 instruments.
Payment
- the tender, transfer,
					 distribution, exchange, or provision of money, goods, services, or anything of
					 economic value.
Person
- includes a natural person or a
					 partnership, corporation, organization, association, facility, institution, or
					 any governmental subdivision, department, board, commission, or other
					 entity.
Physician
- includes a doctor of medicine
					 or a doctor of podiatric medicine.
Referral
- any direction, recommendation,
					 or suggestion given by a health care provider to a patient, directly or
					 indirectly, which is likely to determine, control, or influence the patient's
					 choice of another health care provider for the provision of health care
					 services or items.
Remuneration for Referral
- any arrangement
					 or scheme, involving any remuneration, directly or indirectly, in cash or in
					 kind, between a physician, or an immediate family member of such physician, and
					 another health care provider which is intended to induce referrals by the
					 physician to the health care provider or by the health care provider to the
					 physician, other than any amount paid by an employer to an employee who has a
					 bona fide employment relationship with the employer, for employment in the
					 furnishing of any health care item or service.
B. Construction. Masculine terms wheresoever used in this
					 Chapter shall be deemed to include the feminine.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 37:1744,
					 37:1745,
					 and
					 37:1270(B)(6).