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Self-Referral Rules Finalized by HCFA

Self-Referral Rules Finalized by HCFA

Oncologists who have a financial interest in—or are thinking about investing in—a related business that provides such things as magnetic resonance imaging, computed tomography, or radiology services should pay attention to the final rules from the Health Care Financing Administration (HCFA) on "self-referral." The good news is that the final rules are substantially preferable to the rules that HCFA proposed in 1998. In general, a physician cannot refer a Medicare or Medicaid patient for any of 10 listed services if he or any of his immediate family has a financial interest in that facility.

William Jessee, MD, CMPE, president of the Medical Group Management Association, said his group is "pleased that HCFA has included several important changes in the long-awaited Stark II physician self-referral rules." Stark refers to Rep. Pete Stark (D-Calif), who is responsible for putting these restrictions into law. Among the "important changes" referred to by Dr. Jessee are creation of a new exemption for indirect compensation agreements, expansion of the in-office ancillary services exception, and creation of a new exception for compensation of faculty in academic medical centers. HCFA also changed the way it will define "group practices," making it easier for groups to qualify as a "single legal entity" and giving them more wiggle room in terms of the self-referral rules.

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