Self-Referral Legislation Introduced in Congress
Reps. Speier and Titus Introduce Bill to Prevent Wasteful and Harmful Medicare Spending
WASHINGTON, DC – Congresswomen Jackie Speier (D-San Francisco/San Mateo Counties) and Dina Titus (D-NV), introduced legislation today to close a loophole in Medicare that wastes taxpayer dollars and in some cases harms patients. The Promoting Integrity in Medicare Act (PIMA) would prevent physicians in certain specialties from referring patients to ancillary medical services in which they have an ownership interest and are offered in their offices. Closing this loophole would save an estimated $3.3 billion according to the nonpartisan Congressional Budget Office.
“How many GAO studies outlining the abuse and billions of dollars of Medicare reimbursement to doctors for unnecessary services that are driven purely for personal profit does it take to shut this activity down?” Rep. Speier said. “This is a golden opportunity to put patient health and program health over profits. We should always work to improve the quality and cost-effectiveness of government programs – this bill will save taxpayers money and help seniors who depend on Medicare for their quality of life.”
“I remain committed to protecting seniors’ access to Medicare and ensuring they receive the care they need and deserve,” Rep. Titus said. “Our seniors should be able to make health care decisions based on their best interest, not how it will financially benefit their doctors. The Promoting Integrity in Medicare Act is a common-sense solution to closing the self-referral loophole which will save taxpayer dollars and preserve access to quality care. “
The current law—known as the Stark Law—bars physicians from referring Medicare patients for certain health care services in which they have a financial interest, but includes an “in-office ancillary services exception.” PIMA restores the original intent of the self-referral law by prohibiting self-referral for four complex services: advanced imaging, anatomic pathology, radiation therapy and physical therapy, which are not typically performed at the time of the patient’s initial office visit. This will ensure that incentives driving medical decisions are solely in the patients’ best interests, thereby reducing unnecessary and inappropriate services and costs to the Medicare program. PIMA will also strengthen provisions in the law that maintains access to care for rural Medicare patients.
PIMA is supported by the Alliance for Integrity in Medicare (AIM), which is comprised of the American Clinical Laboratory Association (ACLA), the American Physical Therapy Association (APTA), the Association for Quality Imaging (AQI), the American Society for Radiation Oncology (ASTRO), the American Society for Clinical Pathology (ASCP), the College of American Pathologists (CAP), and the Radiology Business Management Association (RBMA). Please click here for a copy of the bill.