Statute · California Business and Professions Code

Cal. Bus. & Prof. Code § 511 — Advocacy for Appropriate Health Care

Cal. Bus. & Prof. Code § 511

Type
Statute
Source
California Business and Professions Code
Jurisdiction
California
Date
1997-01-01
Current through
Nov 2, 2026 (California Legislative Counsel)

(a) No subcontract between a physician and surgeon, physician and surgeon group, or other licensed health care practitioner who contracts with a health care service plan or health insurance carrier, and another physician and surgeon, physician and surgeon group, or licensed health care…

Citator

Cal. Bus. & Prof. Code § 511 — Advocacy for Appropriate Health Care is in force in the current edition of the Code, and nothing recorded condemns it.

(a) No subcontract between a physician and surgeon, physician and surgeon group, or other licensed health care practitioner who contracts with a health care service plan or health insurance carrier, and another physician and surgeon, physician and surgeon group, or licensed health care practitioner, shall contain any incentive plan that includes a specific payment made, in any type or form, to a physician and surgeon, physician and surgeon group, or other licensed health care practitioner as an inducement to deny, reduce, limit, or delay specific, medically necessary, and appropriate services covered under the contract with the health care service plan or health insurance carrier and provided with respect to a specific enrollee or groups of enrollees with similar medical conditions.

(b) Nothing in this section shall be construed to prohibit subcontracts that contain incentive plans that involve general payments such as capitation payments or shared risk agreements that are not tied to specific medical decisions involving specific enrollees or groups of enrollees with similar medical conditions.