ASSEMBLY, No. 948

 

STATE OF NEW JERSEY

 

Introduced Pending Technical Review by Legislative Counsel

 

PRE-FILED FOR INTRODUCTION IN THE 1996 SESSION

 

 

By Assemblyman FELICE

 

 

An Act concerning billing for clinical laboratory services, amending and supplementing P.L.1975, c.166 and supplementing chapter 9 of Title 45.

 

    Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

    1. (New section) A clinical laboratory licensed pursuant to P.L.1975, c.166 (C.45:9-42.26 et seq.) shall not:

    a. charge, bill or otherwise solicit payment from a patient or third party payer for any clinical laboratory service that is not actually rendered by the licensee unless the patient or third party payer is apprised on the solicitation for payment of the name and address of the clinical laboratory which performed the service and of the itemized charges of the clinical laboratory for the service; or

    b. charge additional charges or otherwise mark-up the charge for a clinical laboratory service that is not actually rendered by the licensee to a patient. Nothing in this subsection shall be construed to prohibit a licensee from including an itemized charge on a solicitation for payment for any service actually rendered to the patient by the licensee.

 

    2. (New section) a. A physician licensed pursuant to Title 45 of the Revised Statutes shall not:

    (1) charge, bill or otherwise solicit payment from a patient or third party payer for any clinical laboratory service that is not actually rendered by the physician unless the patient or third party payer is apprised on the solicitation for payment of the name and address of the clinical laboratory which performed the service and of the itemized charges of the clinical laboratory for the service; or

    (2) charge additional charges or otherwise mark-up the charge for a clinical laboratory service that is not actually rendered by the physician to a patient. Nothing in this subsection shall be construed to prohibit a physician from including an itemized charge on a solicitation for payment for any service actually rendered to the patient by the physician.

    b. A physician who collects any amounts that were billed in violation of this section, is liable for, and shall refund on a timely basis to the person who was billed, any amounts so collected.

    c. A physician who collects any amounts that were billed in violation of this section may be subject to disciplinary action and civil penalties pursuant to sections 8, 9 and 12 of P.L.1978, c.73 (C.45:1-21, 22 and 25).

 

    3. Section 17 of P.L.1975, c.166 (C.45:9-42.42) is amended to read as follows:

    17. No person shall:

    a. Operate, maintain, direct, or engage in the business of operating a clinical laboratory, as herein defined, unless he has obtained a clinical laboratory license from the department, or is exempt under the provisions of this act.

    b. Collect or receive specimens for analysis by an unlicensed laboratory.

    c. Accept specimens for tests from and make reports to persons who are not legally qualified or authorized to submit specimens to clinical laboratories and to receive such reports, but this shall not prohibit the referral of specimens from one licensed clinical laboratory to another similarly licensed under the laws of the state in which it is located, providing the report indicates clearly the clinical laboratory performing the test and the name of the director of such clinical laboratory.

    d. Either personally, or through an agent, solicit referral of specimens to his or any other clinical laboratory or contract to perform clinical laboratory examinations of specimens in a manner which offers or implies an offer of rebates to a person or persons submitting specimens, other fee-splitting inducements, participation in any fee-splitting arrangements or other unearned remuneration.

    e. Obstruct or interfere with the department or any officer or employee thereof in the performance of any duty imposed by this act.

    f. Collect any amounts that were billed in violation of section 1 of P.L. , c. (C. )(pending before the Legislature as this bill).

(cf: P.L.1975, c.166, s.17)

 

    4. Section 18 of P.L.1975, c.166 (C.45:9-42.43) is amended to read as follows:

    18. a. Any person convicted of violating any provision of this act or of any rule or regulation adopted hereunder shall be subject to a penalty of not less than $100.00 nor more than $1,000.00 for each violation. The penalty shall be collected, and enforced in summary proceedings under the Penalty Enforcement Law (N.J.S.2A:58-1 et seq.).

    b. A clinical laboratory which collects any amounts that were billed in violation of section 1 of P.L. , c. (C. )(pending before the Legislature as this bill), is liable for, and shall refund on a timely basis to the person who was billed, any amounts so collected.

    c. A clinical laboratory which collects any amounts that were billed in violation of section 1 of P.L. , c. (C. )(pending before the Legislature as this bill), may be subject to disciplinary action and civil penalties pursuant to sections 15 and 18 of P.L.1975, c.166 (C.45:9-42.40 and 42.43).

(cf: P.L.1975, c.166, s.18)

 

    5. (New section) The Director of the Division of Consumer Affairs in the Department of Law and Public Safety shall review the effectiveness of P.L. , c. (C. )(pending before the Legislature as this bill) in preventing clinical laboratories and physicians from imposing mark-up charges for clinical laboratory services not actually rendered by the laboratory or the physician to the patient, and shall report his findings and recommendations to the Legislature and the Governor within one year after the effective date of this act.

 

    6. This act shall take effect immediately.

 

 

STATEMENT

 

    This bill prohibits clinical laboratories and physicians from imposing mark-up charges for clinical laboratory services that are not actually rendered by the laboratory or physician to the patient.

    Specifically, the bill forbids a clinical laboratory or physician to:

         charge, bill or otherwise solicit payment from a patient or third party payer for any clinical laboratory service that is not actually rendered by the clinical laboratory or physician unless the patient or third party payer is apprised on the solicitation for payment of the name and address of the clinical laboratory which performed the service and of the itemized charges of the clinical laboratory for the service; or

          charge additional charges or otherwise mark-up the charge for a clinical laboratory service that is not actually rendered by the clinical laboratory or physician to a patient.

    The bill does not prohibit a reasonable drawing and processing fee for laboratory specimens prepared in the clinical laboratory or in the office of a physician.

    A clinical laboratory or physician collecting any amounts that were billed in violation of the provisions of the bill, is liable for, and shall refund on a timely basis to the person who was billed, any amounts so collected.

    The bill provides that:

          a physician who collects any amounts that were billed in violation of this bill may be subject to disciplinary action and civil penalties pursuant to sections 8, 9 and 12 of P.L.1978, c.73 (C.45:1-21,- 22 and -25);

          a clinical laboratory which collects any amounts that were billed in violation of the bill may be subject to disciplinary action and civil penalties pursuant to sections 15 and 18 of P.L.1975, c.166 (C.45:9-42.40 and -42.43); and

          the Director of the Division of Consumer Affairs in the Department of Law and Public Safety shall review the effectiveness of the bill in preventing clinical laboratories and physicians from imposing mark-up charges for clinical laboratory services not actually rendered by the laboratory or the physician to the patient, and shall report his findings and recommendations to the Legislature and the Governor within one year after the effective date of the bill.

 

 

 

Prohibits clinical laboratories and physicians from charging fees for services not actually rendered.