Cal. Code Regs. Tit. 8, § 41.7 - Gifts to Medical Evaluators
(a)
No physician reporting as an Agreed Medical Evaluator or a Qualified Medical
Evaluator shall accept gifts that have a total fair market value in the
aggregate of three hundred sixty dollars ($ 360) or more, from any single
source that handles California workers' compensation matters, in the course of
any consecutive twelve months. The sources include, but are not limited to, one
or more attorneys, physicians, employers, claims administrators, medical or
health care or insurance or utilization review business entities. This
prohibition shall not include reasonable and appropriate income earned from a
Medical Provider Network as defined in Labor Code sections
4616 et seq,
from a Health Care Organization as defined in Labor Code sections
4600.3 et seq,
from a Preferred Provider Organization or managed care organization as defined
in Health and Safety Code sections
1340
et seq for services performed as a treating physician nor for reasonable and
appropriate income paid for services performed as reviewing physician or
medical director pursuant to Labor Code section
4610, or for
services performed as an Agreed Medical Evaluator or Qualified Medical
Evaluator.
(b) For the purposes of
this section, "Gift" means any payment to the extent that consideration of
equal or greater value is not received. It includes any rebate or discount in
the price of anything of value, unless the rebate or discount is also made in
the regular course of business to members of the public, and any loan,
forgiveness or other thing of value having a fair market value in excess of $
360 in the aggregate.
(c) Any
person who claims that a payment, rebate, discount, loan, forgiveness, or other
thing of value is not a gift by reason of receipt of consideration has the
burden of proving that the consideration received is of equal or greater
value.
(d) A Qualified Medical
Evaluator who violates any portion of this section shall be subject to
disciplinary action pursuant to section
60 et seq of these
regulations.
Notes
Note: Authority cited: Sections 133, 139.2(o) and 5307.3, Labor Code. Reference: Sections 139.2 and 139.3, Labor Code.
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