Doctors Still Profit From Medicare Referrals Despite Law

Amanda Foley

In a letter to a friend, the manager of a Florida urology practice worried in 2010 that her

company would attract federal scrutiny for its frequent use of an expensive bladder-cancer test
(Carreyrou and Adamy, 2014). The manager’s concern involved a program at 21st Century
Oncology Holdings Inc., a national chain of cancer practices, that gives its urologists a financial incentive to order the test from a central in-house lab (Carreyrou and Adamy, 2014). A federal law since the 1990s has prohibited “self-referral,” in which doctors can profit from Medicarereimbursed procedures they order (Carreyrou and Adamy, 2014). However, the 21st Century
Oncology and many physician groups around the country have found ways to do it anyway, exploiting an exception to the law in ways its writers didn’t anticipate (Carreyrou and Adamy,
2014). Many physician groups have found ways to do it anyway, exploiting a loophole to the law in ways its writers didn’t anticipate, reports The Wall Street Journal (Carreyrou and Adamy,
2014).

Pete Stark’s landmark law to curb medical self-referral hasn’t worked out how he planned

(Adamy, 2014). His retirement, on the other hand, is playing out just how he’d like it to (Adamy,
2014). “It’s a lot of fun,” the former California Democratic congressman said of life after Capitol
Hill during a recent interview (Adamy, 2014). “I’m lazy and just enjoying getting ready for the winter” (Adamy, 2014). Self-referral occurs when doctors refer patients needing services such as lab tests or MRIs to entities from which they benefit financially (Adamy, 2014). The Stark Law, passed two decades ago, sought to ban self-referral when the patient is covered by Medicare or another government plan (Adamy, 2014). But many medical groups have gotten around the law, as the Journal reports in a page-one article today (Adamy, 2014).

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