KRS 304.39-215: Prohibition of referral to entity with which provider has financial

relationship -- Reparations benefits.

(1) As used in this section and in KRS 304.99-060:

(a) "Compensation arrangement" has the same meaning as in 42 U.S.C. sec.

1395nn, as amended; and

(b) "Health care provider" or "provider" means:

1. An individual who is licensed under KRS 309.353 or KRS Chapter 311,

311A, 311B, 312, 313, 314, 314A, 315, 319, 319A, 319B, 320, or 327

and who is not enrolled in the Kentucky Medicaid program; or

2. A medical laboratory, as defined in KRS 333.020, that is not enrolled in

the Kentucky Medicaid program.

(2) Except as otherwise provided in subsection (3) of this section:

(a) If a health care provider, directly or indirectly, has either of the foll owing

financial relationships with a person or entity, the provider shall not make a

referral to the person or entity for the furnishing of health care services for

which payment may be made from basic or added reparation benefits provided

under this subtitle:

1. An ownership or investment interest in the person or entity, whether

through debt, equity, or other means; or

2. A compensation arrangement between the provider, directly or

indirectly, and the person or entity; and

(b) No person or entity shall present, cause to be presented, or collect payment on

a claim or bill for health care services referred to the person or entity that the

person or entity knows or should know is in violation of paragraph (a) of this

subsection.

(3) Any conduct or activity wh ich is permitted by or protected under 42 U.S.C. sec.

1395nn(b) to (e), as amended, 42 U.S.C. sec. 1320a -7b(b)(3), as amended, or a

federal regulation adopted under those sections, as amended, shall not be deemed to

violate this section, and the conduct or activity shall be accorded the same

protections allowed under these federal laws and regulations.

(4) (a) No insurer shall be required to pay basic or added reparations benefits to a

person or entity for health care services referred to that person or entity in

violation of this section.

(b) If a person or entity collects any amount in basic or added reparatio ns benefits

in violation of this section, the person or entity shall refund, on a timely basis,

the amount collected.