Ask almost any healthcare provider who regularly treats personal injury patients where new patients come from, and you’ll probably hear the same answer: Everywhere.

Some are referred by attorneys. Some are referred by existing patients. Some come from family members.

Some are sent by chiropractors. Others arrive from urgent care physicians, emergency departments, primary care doctors, physical therapists, or specialists.

Some simply find the practice through an internet search or a practice’s marketing efforts.

Patient referral patterns have never been simple.

And identifying referral originations can be impossible, especially if a patient fails to know or disclose.

That is why one of SB 623’s newest requirements deserves careful review and I think change.

Not because transparency is inherently problematic. Transparency is needed in all aspects of all things and by all in my own opinion.

But because healthcare providers and physicians now face new administrative responsibilities that may require changes to office procedures, documentation systems, insurance coverage, and compliance protocols when they aren’t best positioned to comply.

The important question is not whether transparency is appropriate.

The important question is: Who is in the best position to document and verify referral origination information?

What the Statute Requires

SB 623 provides that, upon request, a lien-based healthcare provider must provide a declaration under penalty of perjury indicating whether the patient was referred by an attorney, law firm, or someone acting on their behalf, together with the approximate number of referrals received from that attorney or law firm during the preceding twenty-four months.

That language appears straightforward. Implementing it will not be.

It Sounds Easier Than It Is

Imagine the following.

A patient is injured in an Uber accident. The emergency department recommends follow-up care. The patient hires an attorney. The attorney gives the patient the names of three orthopedic surgeons. The patient also searches online. A friend recommends one of those same physicians.

The patient ultimately schedules with Dr. Jones.

Who referred the patient?

Was it: The emergency physician? The attorney? The friend? Google? The patient?

Reasonable people could answer that question differently.

Healthcare providers now face the practical challenge of accurately documenting referral pathways that are often more complicated than they appear.

Healthcare Offices Were Never Designed for This

Most personal injury practices maintain excellent medical records.

They document consents. Evaluations. Diagnoses. Treatment plans. Projected costs of care. Imaging. Progress notes. Billing. Coding. Appointments.

But many have never needed formal systems designed specifically to audit referral sources, let alone over a rolling twenty-four-month period.

That is an entirely different administrative function and time, cost, and staff burden.

Office staff now may need to ask additional intake questions. Electronic health record systems may require modification. Referral logs have become more important and are now part of compliance protocols. Internal audits may become advisable.

These changes require time. Training. Resources. Documentation. And consistency.

And how accurate will this recording really be?

Why Accuracy Matters

The declaration is made under penalty of perjury.

A “penalty of perjury” means that a person making an attested statement will face potential civil penalties and even possibly criminal charges if they intentionally lie. This concept ensures truthfulness in attestations found in legal documents like declarations under penalty of perjury.

Being straight, to be guilty, the lie must normally be intentional and pertain to a “material” fact, meaning it is significant and relevant enough.

Perjury is considered a felony in most jurisdictions. Under federal law, it is punishable by up to $250,000 in fines and up to 5 years in federal prison. State-level penalties also apply.

So when you sign something under “penalty of perjury,” you better be taking it very seriously.

And even if you know you never lied, if you are served with a criminal complaint, a licensing board complaint, an insurer non-compliance threat, and needing to hire an attorney to prove it, how much will it cost you in hourly attorney rates to prove you were right if your malpractice insurer says it’s an uncovered claim?

That does not mean providers should panic.

But it does mean offices should avoid assumptions.

Staff should never guess.

Documentation should be based upon information obtained through consistent intake procedures.

If uncertainty exists, practices should develop protocols for documenting what is known, what is reported by the patient, and what cannot reasonably be confirmed.

Good compliance begins with good systems.

And safety comes from risk transfer of unintentional mistakes usually through insurance coverage.

But there’s another problem providers and physicians can’t control? The accuracy by their patients.

Will patients be honest? Will patients go with who suggested the provider or physician last? Must a provider now contact the indicated referral source and confirm for accuracy?

And what will be the parameters of “approximate” given you must approximate those referrals? How far off will turn an approximation mistake to an intentional lie.

You also will not be able to say “I don’t maintain that information.” You are now legally required to do so if you treat any rideshare car crash patient, and as I have repeatedly said, I believe SB 623 will later be expanded to all personal injury cases.

And the largest question of all: Why is this even a physician or provider problem and now obligation “under penalty of perjury”?

Should Providers Be the Primary Source?

This raises an interesting policy question.

If Uber and the Legislature seek accurate reporting of attorney referrals, who possesses the most direct knowledge?

The attorney and law firm who made the referral!

The attorney or the law firm knows whether the firm referred the patient directly or even indirectly. They have control, or at least far better control, over the referral sources and middlemen they use.

The attorney and law firm is the referring source.

SB 623 itself addresses referrals from attorneys to providers, not the other way around.

The patient knows how they chose the provider.

The provider knows how the patient was documented during intake.

Each participant possesses part of the story.

No single participant necessarily possesses all of it, other than the law firm themselves.

Logic alone would dictate that if you were going to report referrals, that would then need to be from the referral source itself. That would be the law firm. Yet that isn’t the legal mandate.

It’s not attorneys who must declare under penalty of perjury where they send referrals. It’s the providers and physicians who receive them, assuming they even know the actual true source.

It also seems logical that when this referral declaration mandate was first presented in the closed-door negotiations by Uber and the Legal Lobby, it was put on the table by Uber for attorneys to declare.

And what does a little Sherlock Holmes deduction lead us to?

That the Legal Lobby, not wanting to put that burden and exposure on their members, shifted that burden to medical providers and physicians.

Attorneys win. Providers and physicians lose.

The burden of compliance, and the risk associated with that compliance and declarations “under penalty of perjury” falls upon the medical professionals not the legal professionals.

And will the malpractice coverage of medical professionals even cover this new legal exposure of the correctness and lawsuits that might flow from incorrect mandated referral declarations?

That reality suggests providers should approach these declarations thoughtfully and very carefully. Rather than assuming every referral pathway is obvious and that they have no real or significant exposure, they need to wake up to litigation and legal exposure reality and also discover if all or any part of that exposure is transferable to their malpractice insurance carrier.

A Better Intake Process

Regardless of one’s opinion about SB 623, providers will have to use this moment to institute new processes and procedures that track referrals accurately and bear the cost of time, money and resources for that compliance.

Practices may wish to now document:

• How the patient first learned about the practice
• Whether an attorney provided provider names
• Whether another healthcare provider made the referral
• Whether the patient independently selected the provider
• Whether multiple referral sources were involved

The more consistently that information is collected, the easier future compliance becomes.

What you provide in a declaration and how others will view that accuracy and “approximation” may have adverse legal consequences.

Good documentation protects everyone. There is just no way to know exactly how accurate you are or can be and what impact that may have.

All we know is this: If requested, likely by adjusters or defense attorneys as routine, it must be provided. By the physician or provider. Not the attorney or law firm.

Is that how it should be?

Transparency is Not the Enemy

Some providers immediately view additional disclosure requirements as burdensome.

Others view them as opportunities to distinguish ethical practices from questionable ones.

Transparency, standing alone, is almost always good, desirable and should be insisted upon applying to everyone in the personal injury ecosystem.

The important question here, however, is whether the burden of attorney referral reporting requirements placed upon medical providers and physicians are practical, accurate, and fairly allocated.

Healthcare providers should welcome transparency when it promotes confidence in ethical care.

At the same time, administrative requirements should recognize the realities of how patients actually enter medical practices.

The Bigger Lesson

SB 623 reminds us that modern healthcare increasingly requires more than clinical excellence and better business management.

Providers are expected to understand compliance. Consents. Documentation. Privacy. Billing. Coding. Quality reporting. Electronic health records.

And now, in some settings, referral origination and enhanced referral documentation.

Medicine continues to evolve. So does the regulatory environment surrounding it.

Practices that develop strong administrative and tracking systems today will be better positioned regardless of how future legislation evolves.

Looking Beyond SB 623

Perhaps the most important takeaway is not simply compliance with one statute.

It is recognizing that public policy increasingly expects transparency throughout the personal injury ecosystem. Providers. Attorneys. Patients. Insurers. Financial companies.

Everyone should expect greater scrutiny.

Those who embrace accurate documentation, transparency and ethical practices will likely be in the strongest position moving forward.

Next in the Series

The Silent Casualty

How Changes in Medical Funding Could Affect Patient Access to Care

We’ll examine one of the least discussed but potentially most important questions raised by SB 623: If providers, surgery centers, and funding companies become less willing to assume financial risk, what happens to patients who have no other way to obtain medically necessary treatment?