Current law prohibits a health care provider who receives reimbursement through the state's medical assistance program (medicaid) from making referrals for medical services to an entity owned or controlled by the provider or an immediate family member of the provider. The bill extends this prohibition to include all health care providers, not only those who receive reimbursement through medicaid.
Sections 2 and 3 of the bill make the prohibited referrals a deceptive trade practice under the 'Colorado Consumer Protection Act', entitling any person harmed by the violator's conduct to damages, including treble damages in a case involving bad-faith conduct. In addition to these private remedies, the Colorado attorney general is authorized to seek injunctions and civil penalties, require reimbursement of charges collected, and refer violators for investigation of insurance fraud.
Section 4 allows insurers to withhold payment of questionable charges pending investigation pursuant to the prompt payment statute.
(Note: This summary applies to this bill as introduced.)