58-67-501 - Unlawful conduct.
58-67-501. Unlawful conduct.
(1) "Unlawful conduct" includes, in addition to the definition in Section 58-1-501:
(a) buying, selling, or fraudulently obtaining, any medical diploma, license, certificate, orregistration;
(b) aiding or abetting the buying, selling, or fraudulently obtaining of any medicaldiploma, license, certificate, or registration;
(c) substantially interfering with a licensee's lawful and competent practice of medicine inaccordance with this chapter by:
(i) any person or entity that manages, owns, operates, or conducts a business having adirect or indirect financial interest in the licensee's professional practice; or
(ii) anyone other than another physician licensed under this title, who is engaged in directclinical care or consultation with the licensee in accordance with the standards and ethics of theprofession of medicine; or
(d) entering into a contract that limits a licensee's ability to advise the licensee's patientsfully about treatment options or other issues that affect the health care of the licensee's patients.
(2) "Unlawful conduct" does not include:
(a) establishing, administering, or enforcing the provisions of a policy of accident andhealth insurance by an insurer doing business in this state in accordance with Title 31A, InsuranceCode;
(b) adopting, implementing, or enforcing utilization management standards related topayment for a licensee's services, provided that:
(i) utilization management standards adopted, implemented, and enforced by the payerhave been approved by a physician or by a committee that contains one or more physicians; and
(ii) the utilization management standards does not preclude a licensee from exercisingindependent professional judgment on behalf of the licensee's patients in a manner that isindependent of payment considerations;
(c) developing and implementing clinical practice standards that are intended to reducemorbidity and mortality or developing and implementing other medical or surgical practicestandards related to the standardization of effective health care practices, provided that:
(i) the practice standards and recommendations have been approved by a physician or bya committee that contains one or more physicians; and
(ii) the practice standards do not preclude a licensee from exercising independentprofessional judgment on behalf of the licensee's patients in a manner that is independent ofpayment considerations;
(d) requesting or recommending that a patient obtain a second opinion from a licensee;
(e) conducting peer review, quality evaluation, quality improvement, risk management, orsimilar activities designed to identify and address practice deficiencies with health care providers,health care facilities, or the delivery of health care;
(f) providing employment supervision or adopting employment requirements that do notinterfere with the licensee's ability to exercise independent professional judgment on behalf of thelicensee's patients, provided that employment requirements that may not be considered to interferewith an employed licensee's exercise of independent professional judgment include:
(i) an employment requirement that restricts the licensee's access to patients with whomthe licensee's employer does not have a contractual relationship, either directly or throughcontracts with one or more third-party payers; or
(ii) providing compensation incentives that are not related to the treatment of anyparticular patient;
(g) providing benefit coverage information, giving advice, or expressing opinions to apatient or to a family member of a patient to assist the patient or family member in making adecision about health care that has been recommended by a licensee; or
(h) any otherwise lawful conduct that does not substantially interfere with the licensee'sability to exercise independent professional judgment on behalf of the licensee's patients and thatdoes not constitute the practice of medicine as defined in this chapter.
Amended by Chapter 116, 2001 General Session