Current through 2023-2024 Legislative Session Chapters 1-374, 376-386, 393, 394, 397, 398, 406-412, 414, 415, 421, 424, 427, 429, 430, 432-456, 460, 461, 471, 473, 475, 478, 480, 483, 484, 488, 490
Section 26-5-80 - Prohibited remunerations and acts; exemptions; penalties(a) As used in this Code section, the term: (1) "Health care provider" means: (A) Any person licensed under Chapter 9, 10A, 11, 11A, 26, 28, 30, 33, 34, 35, 39, or 44 of Title 43 or any hospital, nursing home, home health agency, institution, or medical facility licensed or defined under Chapter 7 of Title 31. Such term shall also include any corporation, professional corporation, partnership, limited liability company, limited liability partnership, authority, or other entity composed of such health care providers; and(B) A substance abuse provider.(2) "Health care provider network entity" means a corporation, professional corporation, partnership, limited liability company, limited liability partnership, or authority owned or operated by two or more health care providers and organized for the purpose of entering into agreements with health insurers, health care purchasing groups, Medicaid, or Medicare.(3) "Health insurer" means an accident and sickness insurer, health care corporation, health maintenance organization, or provider sponsored health care corporation or any similar entity regulated by the Commissioner of Insurance.(4) "Recovery residence" means a residential dwelling unit, or other form of group housing, that is offered or advertised through any means, including oral, written, electronic, or printed means, by any person or entity as a residence that provides a peer supported, alcohol-free, and drug-free living environment.(5) "Substance abuse provider" means:(A) Any state owned or state operated hospital, community mental health center, or other facility utilized for the diagnosis, care, treatment, or hospitalization of persons who are alcoholics, drug dependent individuals, or drug abusers, and any other hospital or facility within the State of Georgia approved for such purposes by the Department of Behavioral Health and Developmental Disabilities;(B) Any community service provider contracting with any state or local entity to furnish mental health, developmental disability, and addictive disease services;(C) Any drug abuse treatment and education program and narcotic treatment program licensed under this chapter; and(D) Any recovery residence.(b) It shall be unlawful for any person, including any substance abuse provider, to: (1) Pay or offer to pay any remuneration, including, but not limited to, a commission, benefit, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form, to induce the referral of a patient or patronage to or from a substance abuse provider;(2) Solicit or receive any remuneration, including, but not limited to, a commission, benefit, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form, in return for the referral of a patient or patronage to or from a substance abuse provider;(3) Solicit or receive any remuneration, including, but not limited to, a commission, benefit, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form, in return for the acceptance or acknowledgment of treatment from a substance abuse provider; or(4) Aid, abet, advise, or otherwise participate in the conduct prohibited by paragraphs (1) through (3) of this subsection.(c) This Code section shall not apply to:(1) Any discount, payment, waiver of payment, or payment practice not prohibited by 42 U.S.C. Section 1320a-7b(b) or its corresponding federal regulations regardless as to whether such discount, payment, waiver of payment, or payment practice involves a federal healthcare program; or any fraternal benefit society providing health benefits to its members as authorized pursuant to Chapter 15 of Title 33;(2) Any payment, compensation, or financial arrangement within a group practice as defined in Code Section 43-1B-3, provided that such 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 for professional services;(4) Commissions, fees, or other remuneration lawfully paid to insurance agents as provided under Title 33;(5) Payments by a health insurer that 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 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 care, mental health, or substance abuse goods or services under a health benefit plan when such payments are for goods or services under the plan; provided, however, that nothing in this paragraph shall be construed to affect whether a health care provider network entity is an insurer required to be licensed under Title 33;(7) Insurance advertising gifts lawfully permitted under Code Section 33-6-4; or(8) Payments by a substance abuse provider to a health care, mental health, or substance 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 health care providers, provided that such 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;(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; and(D) Charges and collects fees from a health care provider 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 of the goods or services provided by the health care provider.(d)(1) Any person, including an officer, partner, agent, attorney, or other representative of a firm, joint venture, partnership, business trust, syndicate, corporation, or other business entity, who violates any provision of this Code section, when the prohibited conduct involves fewer than ten patients, commits a misdemeanor and, upon conviction thereof, shall be punished by imprisonment for not more than 12 months and by a fine of not more than $1,000.00 per violation.(2) Any person, including an officer, partner, agent, attorney, or other representative of a firm, joint venture, partnership, business trust, syndicate, corporation, or other business entity, who violates any provision of this Code section, when the prohibited conduct involves ten or more patients but fewer than 20 patients, commits a felony and, upon conviction thereof, shall be punished by imprisonment for not more than five years and by a fine of not more than $100,000.00 per violation.(3) Any person, including an officer, partner, agent, attorney, or other representative of a firm, joint venture, partnership, business trust, syndicate, corporation, or other business entity, who violates any provision of this Code section, when the prohibited conduct involves 20 or more patients, commits a felony and, upon conviction thereof, shall be punished by imprisonment for not more than ten years and by a fine of not more than $500,000.00 per violation.(e) Notwithstanding any other law to the contrary, the Attorney General or district attorney of the judicial circuit in which any part of the violation occurred may maintain an action for injunctive relief or other process to enforce the provisions of this Code section.(f) For prosecutions under this Code section, venue shall be proper in any county in this state where any act was committed in furtherance of the unlawful conduct.(g) The party bringing an action under this Code section may recover reasonable expenses in obtaining injunctive relief, including, but not limited to, investigative costs, court costs, reasonable attorney's fees, witness costs, and deposition expenses.(h) The provisions of this Code section are in addition to any other civil, administrative, or criminal actions provided by law and may be imposed against both corporate and individual defendants.Added by 2021 Ga. Laws 205,§ 1, eff. 7/1/2021.