Page:United States Statutes at Large Volume 103 Part 3.djvu/168

 103 STAT. 2236 PUBLIC LAW 101-239—DEC. 19, 1989 SEC. 6204. PHYSICIAN OWNERSHIP OF, AND REFERRAL TO, HEALTH CARE ENTITIES. (a) PROHIBITION OF CERTAIN FINANCIAL ARRANGEMENTS BETWEEN REFERRING PHYSICIANS AND CUNICAL LABORATORIES. — Title XVIII of the Social Security Act is amended by inserting after section 1876 the following new section: "LIMITATION ON CERTAIN PHYSICIAN REFERRALS 42 USC 1395nn. "SEC. 1877. (a) PROHIBITION OF CERTAIN REFERRALS.— "(1) IN GENERAL.— Except as provided in subsection (b), if a physician (or immediate family member of such physician) has a financial relationship with an entity specified in paragraph (2), then— "(A) the physician may not make a referral to the entity for the furnishing of clinical laboratory services for which " payment otherwise may be made under this title, and (B) the entity may not present or cause to be presented a claim under this title or bill to any individual, third party payor, or other entity for clinical laboratory services fur- nished pursuant to a referral prohibited under subpara- graph (A). "(2) FINANCIAL RELATIONSHIP SPECIFIED. —For purposes of this section, a financied relationship of a physician (or immediate family member) with an entity specified in this paragraph is— "(A) except as provided in subsections (c) and (d), an ownership or investment interest in the entity; or "(B) except as provided in subsection (e), a compensation arrangement (as defined in subsection (h)(l)(A)) between the physician (or immediate family member) and the entity. An ownership or investment interest described in subparagraph (A) may be through equity, debt, or other means. " (b) GENERAL EXCEPTIONS TO BOTH OWNERSHIP AND COMPENSATION ARRANGEMENT PROHIBITIONS. — Subsection (a)(1) shall not apply in the following cases: "(1) PHYSICIANS' SERVICES. —In the case of physicians' services (as defined in section 1861(q)) provided personally by (or under the personal supervision of) another physician in the same group practice (as defined in subsection (h)(4)) as the referring physician. (2) IN-OFFICE ANCILLARY SERVICES. — In the case of services— "(A) that are furnished— "(i) personally by the referring physician, personally by a physician who is a member of the same group practice as the referring physician, or personally by individuals who are employed by such physician or group practice and who are personally supervised by the physician or by another physician in the group practice, and "(iiXD in a building in which the referring physician (or another physician who is a member of the same group practice) furnishes physicians' services unrelated to the furnishing of clinical laboratory services, or "(II) in the case of a referring physician wha is a member of a group practice, in another building which is used by the group practice for the centralized provi- sion of the group's clinical laboratory services, and

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