§ 131E-290. Prohibited practice. - North Carolina Statutes

§ 131E‑290. Prohibited practice.

(a)        No provider sponsored organization or sponsoring provider,unless licensed as an insurer under Chapter 58 of the General Statutes may usein its name, contracts, or literature any of the words "insurance","casualty", "surety", "mutual", or any otherwords descriptive of the insurance, casualty, or surety business or deceptivelysimilar to the name or description of any insurance or surety corporation doingbusiness in this State.

(b)        No provider sponsored organization or sponsoring providershall engage in any activity or conduct which is prohibited by the terms of thePSO's Medicare contract.

(c)        Unless otherwise preempted by federal law or mandated by theMedicare program, a PSO shall not discriminate with respect to participation,reimbursement, or indemnification as to any provider who is acting within thescope of the provider's license or certification under applicable State law,solely on the basis of that license or certification. This subsection does notpreclude a PSO from including providers only to the extent necessary to meetthe needs of the organization's enrollees or from establishing any measuredesigned to maintain quality and control costs consistent with theresponsibilities of the organization. (1998‑227, s. 1.)