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Compliance Program

Compliance Program

Standard 8 — Prevention Of Improper Referrals or Kickbacks

University personnel must not accept or offer, for themselves or for the university, anything of value in exchange for referrals of business or the referral of patients.

  • Federal law generally prohibits anyone from offering anything of value to a Medicare, Medicaid or Tricare patient that is likely to influence that person's decision to select or receive care from a particular health care provider.

  • University personnel may not offer or receive any item or service of value as an inducement for the referral of business or patients to or from university providers or practitioners or outside facilities.  Regulations prohibit improper influence that could alter clinical decisions or purchasing decisions, increase costs, or lead to over or under utilization of services.

  • In addition to the prohibition regarding exchange of goods or money to induce referral, certain prohibitions exist with regard to receipt of gifts by university personnel.

  • Federal law prohibits a physician from referring a patient for certain health services to a facility where that physician (or a family member) has a financial interest (Stark regulations).

  • University personnel should adhere to the university's policy as defined in the Compendium of University of California Specialized Policies, Guidelines and Regulations Related to Conflict of Interest, the university's Gifts Policy, as well as the California Political Reform Act.

  • Each campus shall establish procedures for the review of all pricing and discounting decisions to assure that appropriate factors have been considered and that the basis for such arrangements are documented.

  • The following types of business arrangements must be reviewed and approved by one or more of the campus executive management team to assure compliance with university policies and federal regulations. The executive management team may determine that certain business transactions must first be approved, in accordance with university policy, by the university's Board of Regents charged with taking action on such matters:

    1. pursuing joint ventures, partnerships, corporations;
    2. developing hospital financial arrangements with hospital-based physicians;
    3. entering into an arrangement to lease or purchase equipment or supply items from a vendor; or
    4. acquiring physicians practices, hospitals, and other facilities, clinical, and ancillary services, or any other entities.