Congressional Bill Introduced to Close the In-Office Ancillary Services Exception under the Stark Law

On Thursday, August 1, 2013, Congresswoman Jackie Speier (D-CA-14) introduced the “Promoting Integrity in Medicare Act of 2013 (PIMA) in the United States House of Representatives. As the law stands, Stark Law prohibits physicians from referring Medicare patients for certain health care services in which they have a financial interest. However, there is an in-office ancillary service exception included in the Stark Law, which according to two recent reports issued by the United States Government Accountability Office (GAO), has led to the overutilization of self-referrals. The reports estimate that in 2010 alone, Medicare could have saved $109 million on advanced imaging and $69 million on anatomic pathology if self-referring physicians had referred the same number of procedures as non-self-referring physicians.

According to Congresswoman Speier’s press release, the proposed bill would eliminate diagnostic MRI, CT, PET, and other advanced diagnostic imaging services, anatomic pathology, radiation oncology, and physical therapy from the in-office exception because they are services that are rarely provided on the same day as the initial office visit. According to the release, “the goal of PIMA is to cut spending in Medicare by hundreds of millions annually without reducing the essential care that seniors rely on.”

On the same day that the bill was introduced in Congress, the Alliance for Integrity in Medicare (AIM) issued a joint statement that applauded the strong leadership of Congresswoman Speier and showed its support for PIMA. The statement explained that if PIMA is enacted, the ability of collaborative group practices to operate as they do today will be preserved and physicians will continue to be allowed to order x-rays and other routine clinical laboratory tests in order to diagnose and treat patients during office visits. The AIM reiterated that reforming the in-office exception through the passing of PIMA will ensure that Medicare patients will “receive the highest quality and safest health care most appropriate to their needs, and Medicare policy incentives are properly aligned saving billions of dollars, which is in the best interests of beneficiaries, providers, and our nation’s health system overall.”

To see the full text of the Promoting Integrity in Medicare Act of 2013, click here.

To see the full text of the two GAO reports analyzing the in-office exception, click here and here.

To see the full text of the AIM’s statement in support of the bill, click here.

For more information about this topic, contact Adrienne Dresevic, Esq. and Carey Kalmowitz, Esq. at (248) 996-8510.