CQW Panacea-re-brand-rev3


For the Week of July 21, 2014


What does the physician referral law prohibit?


The physician referral law 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 to the law are specified in Title 42 of the Code of Federal Regulations, 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.

More on this topic can be found at www.cms.hhs.gov/PhysicianSelfReferral/01_overview.asp#TopOfPage.


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