2003 Minnesota Statutes

     62J.23 Provider conflicts of interest. 

    Subdivision 1.    Rules prohibiting conflicts of interest. 
  The commissioner of health shall adopt rules restricting 
 financial relationships or payment arrangements involving health 
 care providers under which a person benefits financially by 
 referring a patient to another person, recommending another 
 person, or furnishing or recommending an item or service.  The 
 rules must be compatible with, and no less restrictive than, the 
 federal Medicare antikickback statute, in section 1128B(b) of 
 the Social Security Act, United States Code, title 42, section 
 1320a-7b(b), and regulations adopted under it.  However, the 
 commissioner's rules may be more restrictive than the federal 
 law and regulations and may apply to additional provider groups 
 and business and professional arrangements.  When the state 
 rules restrict an arrangement or relationship that is 
 permissible under federal laws and regulations, including an 
 arrangement or relationship expressly permitted under the 
 federal safe harbor regulations, the fact that the state 
 requirement is more restrictive than federal requirements must 
 be clearly stated in the rule.  

    Subd. 2.    Interim restrictions.  From July 1, 1992, 
 until rules are adopted by the commissioner under this section, 
 the restrictions in the federal Medicare antikickback statutes 
 in section 1128B(b) of the Social Security Act, United States 
 Code, title 42, section 1320a-7b(b), and rules adopted under the 
 federal statutes, apply to all persons in the state, regardless 
 of whether the person participates in any state health care 
 program.  The commissioner shall approve a transition plan 
 submitted to the commissioner by January 1, 1993, by a person 
 who is in violation of this section that provides a reasonable 
 time for the person to modify prohibited practices or divest 
 financial interests in other persons in order to come into 
 compliance with this section.  Transition plans that identify 
 individuals are private data.  Transition plans that do not 
 identify individuals are nonpublic data. 

    Subd. 3.    Penalty.  The commissioner may assess a fine 
 against a person who violates this section.  The amount of the 
 fine is $1,000 or 110 percent of the estimated financial benefit 
 that the person realized as a result of the prohibited financial 
 arrangement or payment relationship, whichever is greater.  A 
 person who is in compliance with a transition plan approved by 
 the commissioner under subdivision 2, or who is making a good 
 faith effort to obtain the commissioner's approval of a 
 transition plan, is not in violation of this section. 

    Subd. 4.    Chapter 62N networks.  (a) The legislature 
 finds that the formation and operation of community integrated 
 service networks will accomplish the purpose of the federal 
 Medicare antikickback statute, which is to reduce the 
 overutilization and overcharging that may result from 
 inappropriate provider incentives.  Accordingly, it is the 
 public policy of the state of Minnesota to support the 
 development of community integrated service networks.  The 
 legislature finds that the federal Medicare antikickback laws 
 should not be interpreted to interfere with the development of 
 community integrated service networks or to impose liability for 
 arrangements between an integrated service network or a 
 community integrated service network and its participating 
 entities. 

    (b) An arrangement between a community integrated service 
 network and any or all of its participating entities is not 
 subject to liability under subdivisions 1 and 2. 

    Subd. 5.    Audits of exempt providers.  The 
 commissioner may audit the referral patterns of providers that 
 qualify for exceptions under the federal Stark Law, United 
 States Code, title 42, section 1395nn.  The commissioner has 
 access to provider records according to section 144.99, 
 subdivision 2.  The commissioner shall report to the legislature 
 any audit results that reveal a pattern of referrals by a 
 provider for the furnishing of health services to an entity with 
 which the provider has a direct or indirect financial 
 relationship. 

    HIST: 1992 c 549 art 1 s 12; 1993 c 247 art 1 s 17; 1993 c 345 
 art 6 s 13; 1994 c 625 art 8 s 23; 1997 c 225 art 2 s 62; 
 1Sp2003 c 14 art 7 s 12