What does the physician referral law prohibit?

The physician referral law (section 1877 of the Social Security Act) prohibits a physician from referring patients to an entity for a designated health service (DHS), if the physician or a member of his or her immediate family has a financial relationship with the entity, unless an exception applies. (The exceptions are specified in 42 CFR Part 411, Subpart J.) The law also prohibits an entity from presenting a claim to Medicare or to any person or other entity for DHS provided under a prohibited referral. No Medicare payment may be made for DHS rendered as a result of a prohibited referral, and an entity must timely refund any amounts collected for DHS performed under a prohibited referral. Civil money penalties and other remedies may also apply under some circumstances. Additional information is available at 

www.cms.hhs.gov/PhysicianSelfReferral/01_overview.asp#TopOfPage

Have questions? I’m here to help.

This field is for validation purposes and should be left unchanged.
This field is for validation purposes and should be left unchanged.
Categories
Accounting and Tax Services Litigation Support Managed Care Consulting Managed Care Contract Negotiations Medical Practice and Healthcare Entity Valuation Medical Practice Assessment Medical Practice Brokerage Medical Practice Embezzlement Consulting Medical Practice Management Medical Practice Merger Advice Medical Strategic Planning Newsletter Personal Financial Planning Oversight Physician Compensation Models Physician Compliance Physician Financial Management Services Retirement Uncategorized
About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read More >

Reed Tinsley, CPA