Vivek Kumar Agrawal MD, Presenter: Nothing to Disclose

Alison Marie Fleury BS, Abstract Co-Author: Nothing to Disclose

Yash Pal Sethi MD, Abstract Co-Author: Nothing to Disclose

To analyze limitations of STARK II laws in preventing or limiting self-referral among non-radiologists.

Literature review and in depth analysis of Sec. 1877 of the Social Security Act [STARK II].

Congress outlawed physician self-referral in 1993, but did not extend the ban to imaging equipment within group practices. As a result, the practice of self-referral in diagnostic imaging has become widespread. In March 2003, the Medicare Payment Advisory Commission to Congress indicated that the utilization of diagnostic imaging is growing more rapidly than any other type of physician service. Strong evidence in literature shows that radiologists, physicians most closely identified with imaging, are not primarily responsible. Legislators have long known, that by allowing physicians to have financial interests in entities to which they refer, significantly increases Medicare and Medicaid expenditures. Self-referral costs the American Health care system estimated $16 billion per year for unnecessary imaging tests.The original goal of Medicare lawmakers was to protect beneficiaries and taxpayers from potentially abusive referral patterns. Stark II, revised in 2001, prohibits physician from referring Medicare and Medicaid patients to an imaging center if the physician or an immediate family member has a financial relationship with the entity, unless an exception such as in-office exception applies.However, in-office loophole has actually encouraged many physicians such as orthopedic surgeons to provide in-house MRI and radiography services, obstetricians to acquire in-house ultrasound capabilities, and cardiologists to bring echocardiography and cardiac SPECT/PET/MRI into their practices. Capturing imaging income has become core business practice for a number of such physician groups at the expense of the American people.

In order for anti-self referral laws to work, in-office exception, to be discussed, must be modified or be eliminated. This is important for radiologists who depend on referrals from other physicians and for third party payers such as Medicare and private insurance companies.

V.K.A.,Y.P.S.,A.M.F.: Authors do not advocate any specific products and services nor have any direct financial interests related to the outcomes of this study.

Agrawal, V, Fleury, A, Sethi, Y, In-office Loophole in STARK II Laws Makes Self-referral Easier for Non-Radiologists.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4416871.html