Physician self-referring

JJOHN0312

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I have an outpatient order from a physician who has signed his own order. Correct or incorrect? If incorrect, is there any references to affirm?

Please let me know. This is being billed to Medicare.

Thank you!
 

thomas7331

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You'd need to provide more information to be able to say - the legality of this would depend on the type of service that is ordered and the financial and employment relationship the physician has with the entity to which the referral is being made. There are exceptions written into the law, for example for physician services and in-office ancillary services. Here is a good overview of the law that might help you though:

https://en.wikipedia.org/wiki/Stark_Law
 

JJOHN0312

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Physician self referring

This physician ordered lab services. Now the bill is being combined with other services not ordered by himself?? Practice address is the same as the facility that provided the services. As such, physician is now retired.
 
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thomas7331

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I'm not sure I completely understand the situation you're describing. If the services are labs, this would be a potential compliance issue if the physician owns a financial interest in the lab and is writing referrals to that same lab. But really the best way to resolve your concern would be to talk to the facility's compliance officer as they will have access to the specific information needed to make a determination about something like this. These laws are complex and there aren't easy answers without reviewing each individual situation in detail.
 

JJOHN0312

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Physician self referring

Yes, I have referred this to the compliance officer for review. Just wanted to make sure first that it was unethical. Thanks for your help!
 
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