California Codes, Business and Professions Code - BPC, Division 2 — Healing Arts, Chapter 1 — General Provisions, Article 1.5 — Advocacy for Appropriate Health Care, Section 511
(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.
Notes
Prohibits health-care subcontracts from paying specific incentives to physicians or other licensed practitioners to deny, reduce, limit, or delay medically necessary and appropriate covered services for particular enrollees or similar groups. Allows general incentive arrangements such as capitation or shared risk when they are not tied to specific medical decisions for specific enrollees or comparable groups.
Use as reference
Lexinter.net | California Code, Business and Professions Code - BPC § 511 | https://laws.lexinter.net/codes/california/business-and-professions-code/division-2/chapter-1/article-1-5/section-511