State Law

North Carolina Gen. Statutes-Chapter 58-Article 3. General Regulations for Insurance

08/13/2023 North Carolina Section 58-3-265

Prohibition on managed care provider incentives

Prohibited financial incentives

An insurer offering a health benefit plan may not offer or pay any type of material inducement, bonus, or other financial incentive to a participating provider to deny, reduce, withhold, limit, or delay specific medically necessary and appropriate health care services covered under the health benefit plan to a specific insured or enrollee. This section does not prohibit insurers from paying a provider on a capitated basis or withholding payment or paying a bonus based on the aggregate services rendered by the provider or the insurer’s financial performance.