55 Pa. Code § 1102.81 - Prohibited acts of a shared health facility and providers practicing in the shared health facility

(a) Prohibited acts of shared health facilities, their owners, operators and administrators and providers practicing in the shared health facility are as follows:

(1) The rental fee for letting space to providers in a shared health facility may not be calculated wholly or partially, directly or indirectly, as a percentage of earnings or billings of the provider for services rendered on the premises in which the shared health facility is located. The operator of each facility shall file a copy of each lease and a renewal thereof with the Department.

(2) No purveyor, whether or not located in a building which houses a shared health facility, shall directly or indirectly offer, pay or give to a shared health facility or its providers, and no shared health facility or its providers may solicit, request, receive or accept from a purveyor, either directly or indirectly, a sum of money, credit or other valuable consideration for:

(i) Recommending or procuring goods, services or equipment of the purveyor.

(ii) Directing patronage or clientele to the purveyor.

(iii) Influencing a person to refrain from using or utilizing goods, services or equipment of a purveyor.

(3) No provider or purveyor may demand or collect a reimbursement contrary to the payment policy of the Medical Assistance Program.

(4) No purveyor may provide to a recipient services, equipment, pharmaceuticals or other medical supplies differing in quantity or in another respect from that described in the payment invoice submitted by the provider to the Department. No purveyor may provide to a recipient services, equipment, pharmaceutical or medical supplies differing in quality, quantity or in another respect from that prescribed.

(5) No recipient may be referred by a provider in a shared health facility or by a person employed in the facility to another provider in the shared health facility except under the following circumstances and restrictions:

(i) The referral shall be medically justified and the record maintained by the referring provider shall clearly indicate the justification for the referral.

(ii) A provider in a shared health facility to whom a recipient is referred shall communicate in writing to the referring provider the diagnostic evaluation and therapy rendered. The referring provider shall incorporate this information into the permanent medical record of the recipient.

(iii) The invoices submitted to the Department by the provider to whom a recipient has been referred shall contain the name and provider number of the referring provider and identify the medical problem which necessitated the referral.

(6) If a pharmacy is located in, or adjacent to, the building in which a shared health facility is located, no recipient may be required to purchase pharmaceuticals at the pharmacy. The shared health facility shall prominently post a notice in the common waiting area informing recipients that all pharmaceuticals prescribed by providers in the facility may be obtained at any participating pharmacy of the choice of the recipient.

(7) No provider may submit an invoice for services or items rendered at a shared health facility which does not contain the provider number of the provider who rendered the service or item and is not signed by the provider after the service or item has been rendered.

(8) No order may be issued by a provider for ancillary clinical services, including, but not limited to X-rays, electrocardiograms, clinical laboratory services, electroencephalograms or medical supplies and equipment which does not contain the professional license number and the medical assistance identification number of the prescriber and the provider number assigned to the facility at which the order was written.

(9) Each provider shall submit a true bill or invoice for services rendered under the program.

(b) In addition to the prohibited acts specified in this section, providers at a shared health facility are subject to the prohibited acts and criminal and civil penalties specified in Chapter 1101 (relating to general provisions).

Notes

55 Pa. Code § 1102.81

This section cited in 55 Pa. Code § 1101.75 (relating to provider prohibited acts).