PRINTER'S NO. 901
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
713
Session of
2019
INTRODUCED BY SANTARSIERO, FONTANA, BREWSTER, TARTAGLIONE,
HUGHES AND COSTA, JUNE 6, 2019
REFERRED TO JUDICIARY, JUNE 6, 2019
AN ACT
Amending Title 18 (Crimes and Offenses) of the Pennsylvania
Consolidated Statutes, in forgery and fraudulent practices,
providing for patient brokering.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 18 of the Pennsylvania Consolidated
Statutes is amended by adding a section to read:
ยง 4122. Patient brokering.
(a) Offense defined.--A person commits the offense of
patient brokering if the person does any of the following:
(1) Offers or pays a commission, benefit, bonus, rebate,
kickback or bribe, directly or indirectly, in cash or in
kind, or engages in a split-fee arrangement, in any form, to
induce the referral of a patient or patronage to or from a
health care provider, health care facility, drug and alcohol
treatment facility, drug and alcohol recovery house or
assisted living residence.
(2) Solicits or receives a commission, benefit, bonus,
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
rebate, kickback or bribe, directly or indirectly, in cash or
in kind, or engages in a split-fee arrangement, in any form,
in return for referring a patient or patronage to or from a
health care provider, health care facility, drug and alcohol
treatment facility, drug and alcohol recovery house or
assisted living residence.
(3) Solicits or receives a commission, benefit, bonus,
rebate, kickback or bribe, directly or indirectly, in cash or
in kind, or engages in a split-fee arrangement, in any form,
in return for the acceptance or acknowledgment of treatment
or care from a health care provider, health care facility,
drug and alcohol treatment facility, drug and alcohol
recovery house or assisted living residence.
(4) Aids, abets, advises or otherwise participates in
the conduct prohibited under paragraph (1), (2) or (3).
(b) Exceptions.--This section does not apply to:
(1) A discount, payment, waiver of payment or payment
practice not prohibited by section 1128B of the Social
Security Act (49 Stat. 620, 42 U.S.C. ยง 301 et seq.) or
regulations promulgated thereunder.
(2) A payment, compensation or financial arrangement
within a group practice provided that the payment,
compensation or financial arrangement is not to or from a
person who is not a member of the group practice.
(3) A payment to a health care provider, health care
facility, drug and alcohol treatment facility or drug and
alcohol recovery house for professional consultation
services.
(4) A payment by a health care insurer that reimburses,
provides, offers to provide or administers health, mental
20190SB0713PN0901 - 2 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
health or substance abuse services under a health insurance
policy.
(5) A payment to or by a health care provider, health
care facility or a health care provider network that is
contracted with a health care insurer, a health care
purchasing group or the Medicare or Medicaid programs to
provide health, mental health or substance abuse services
under a health insurance policy when the payments are for
services under the health insurance policy.
(6) Insurance advertising gifts to individuals that have
a value of not more than $25.
(7) An individual employed by an assisted living
residence, or with whom the assisted living residence
contracts to provide marketing services, if it is clearly
indicated that the individual works with or for the assisted
living residence.
(8) A payment by an assisted living residence to a
referral service that provides information, consultation or
referrals to consumers to assist consumers in finding
appropriate care or housing options for seniors or disabled
adults if the referred consumers are not Medicaid recipients.
(9) An assisted living residence that provides a
monetary reward to a resident of an assisted living residence
who refers a friend, family member or other individual with
whom the resident has a personal relationship to the assisted
living residence.
(c) Penalties.--
(1) Any person who violates this section, where the
prohibited conduct involves less than 10 patients, commits a
felony of the third degree.
20190SB0713PN0901 - 3 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(2) Any person who violates this section, where the
prohibited conduct involves 10 or more patients but fewer
than 20 patients, commits a felony of the second degree.
(3) Any person who violates this section, where the
prohibited conduct involves 20 or more patients, commits a
felony of the first degree.
(d) Definitions.--As used in this section, the following
words and phrases shall have the meanings given to them in this
subsection unless the context clearly indicates otherwise:
"Assisted living residence." As defined under section 1001
of the act of June 13, 1967 (P.L.31, No.21), known as the Human
Services Code.
"Drug and alcohol recovery house." As defined and licensed
or certified under Article XXIII-A of the act of April 9, 1929
(P.L.177, No.175), known as The Administrative Code of 1929.
"Drug and alcohol treatment facility." A facility licensed,
funded or controlled by the Department of Drug and Alcohol
Programs or its agents that provides or makes provision for
full-time or part-time treatment or rehabilitative services for
drug and alcohol abuse and dependence of patients.
"Group practice." A group of two or more health care
providers organized as a partnership, professional corporation
or similar association in which:
(1) Each health care provider who is a member of the
group provides substantially the full range of services which
the health care provider routinely provides, including
medical care, consultation, diagnosis or treatment through
the joint use of shared office space, facilities, equipment
and personnel.
(2) Substantially all of the services of the health care
20190SB0713PN0901 - 4 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
providers in the group are provided through the group, are
billed in the name of the group and payments received are
treated as receipts of the group.
(3) The overhead expenses of and the income from the
group are distributed in accordance with methods previously
determined by members of the group.
"Health care facility." As defined under section 802.1 of
the act of July 19, 1979 (P.L.130, No.48), known as the Health
Care Facilities Act.
"Health care insurer." A person that offers administrative,
indemnity or payment services for health care in exchange for a
premium or service charge under a health insurance policy,
including, but not limited to, an insurance company, association
or exchange issuing health insurance policies in this
Commonwealth, hospital plan corporation as defined in 40 Pa.C.S.
Ch. 61 (relating to hospital plan corporations), professional
health services plan corporation as defined in 40 Pa.C.S. Ch. 63
(relating to professional health services plan corporations),
health maintenance organization, preferred provider
organization, fraternal benefit society, beneficial society and
third-party administrator.
"Health care provider." As defined under 23 Pa.C.S. ยง 6303
(relating to definitions).
"Health care provider network." A corporation, partnership
or limited liability company owned or operated by two or more
health care providers and organized for the purpose of entering
into agreements with health care insurers, health care
purchasing groups or the Medicare or Medicaid programs.
"Health insurance policy." As defined in section 631.1(f) of
the act of May 17, 1921 (P.L.682, No.284), known as The
20190SB0713PN0901 - 5 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Insurance Company Law of 1921.
"Person." A health care provider, health care facility, drug
and alcohol treatment facility, drug and alcohol recovery house
or assisted living residence.
Section 2. This act shall take effect in 60 days.
20190SB0713PN0901 - 6 -
1
2
3
4
5