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HomeWelfare and Institutions CodeDiv. 9Pt. 4.7Ch. 5Art. 3.5§ 16956 Physician Reimbursement Claims

§ 16956 Physician Reimbursement Claims

Welfare and Institutions Code·California
AI Summary·Official Text·Key Terms·Related Statutes·References
AI SummaryVerified

§ 16956 Physician Reimbursement Claims

Key Takeaways

  • •Doctors must follow rules to get paid for emergency care they give.
  • •If a doctor lies or doesn’t keep good records, they might have to pay the money back or get blocked from future payments.
  • •Patient names on claims must be kept secret.
  • •No special treatment—every doctor and hospital gets treated the same way.
  • •Payments only cover emergency care for the first day and the next two days.

Example

A doctor treats a patient in the ER but forgets to keep good records of what they did.

The doctor might not get paid, and if they already got paid, they’ll have to give the money back. If they keep doing this, they might not get paid for any future emergency care.

AI-generated — May contain errors. Not legal advice. Always verify source.

Official Source
View on CA.gov

§ 16956 Physician Reimbursement Claims

(a) The administering agency shall establish procedures and time schedules for submission and processing of reimbursement claims submitted by physicians in accordance with this chapter. (b) Schedules for payment established in accordance with this section shall provide for disbursement of the funds available in the account periodically and at least quarterly, if funds remain available for disbursement, to all physicians who have submitted claims containing accurate and complete data for payment by the dates established by the administering agency. (c) Claims which are not supported by records may be denied by the administering agency, and any reimbursement paid in accordance with this chapter to any physician which is not supported by records shall be repaid to the administering agency, and shall be a claim against the physician. (d) Any physician who submits any claim for reimbursement under this chapter which is inaccurate or which is not supported by records may be excluded from reimbursement of future claims under this chapter. (e) A listing of patient names shall accompany a physician’s claim, and those names shall be given full confidentiality protections by the administering agency. (f) The administering agency shall not give preferential treatment to any facility, physician, or category of physician and shall not engage in practices that constitute a conflict of interest by favoring a facility or physician with which the administering officer has an operational or financial relationship. (g) Payments shall be made only for emergency medical services provided on the calendar day on which emergency medical services are first provided and on the immediately following two calendar days. (h) Notwithstanding subdivision (g), if it is necessary to transfer the patient to a second facility that provides for a higher level of care for the treatment of the emergency condition, reimbursement shall be available for services provided to the facility to which the patient was transferred on the calendar day of transfer and on the immediately following two calendar days. (Amended by Stats. 2005, Ch. 671, Sec. 10. Effective January 1, 2006.)

Last verified: January 23, 2026

Key Terms

reimbursementtreatmentfacilitymedicalpatientclaimemergencyphysician

Related Statutes

  • § 4659.2 Patient Restraint And Seclusion
  • § 5326.75 Electroconvulsive Therapy Consent Rules
  • § 16953 Emergency Services Definition
  • § 17409 Public Assistance Exempt Property
  • § 4646.55 Developmental Disability Facility Payments

References

  • Official text at leginfo.legislature.ca.gov
  • California Legislature. Welfare and Institutions Code. Section 16956.
View Official Source