WASHINGTON, DC – Congresswomen Jackie Speier (D-San Francisco/San Mateo Counties) with Jim McDermott (D-WA), Ranking Member of the House Ways & Means Subcommittee on Health, and Dina Titus (D-NV), introduced legislation today to close a loophole in Medicare that wastes taxpayer dollars and in some cases harms patients. The Promoting Integrity in Medicare Act (PIMA), or H.R. 5088, would prevent physicians in certain specialties from referring patients to ancillary medical services in which they have an ownership interest and are offered in their offices. Closing this loophole would save an estimated $3.3 billion according to the nonpartisan Congressional Budget Office.
“How many GAO studies outlining the abuse and billions of dollars of Medicare reimbursement to doctors for unnecessary services that are driven purely for personal profit does it take to shut this activity down?” said Speier. “This is a golden opportunity to put patient health and program health over profits. We should always work to improve the quality and cost-effectiveness of government programs – this bill will save taxpayers money and help seniors who depend on Medicare for their quality of life.”
“Closing this loophole in the self-referral law is common sense,” said Ranking Member McDermott. “To find savings and improve quality of care, Congress must strengthen the laws that protect Medicare and beneficiaries from wasteful and harmful practices. The Promoting Integrity in Medicare Act does just that, and I am proud to work with Representative Speier to advance this important legislation.”
“I remain committed to protecting seniors’ access to Medicare and ensuring they receive the care they need and deserve,” said Congresswoman Titus. “Our seniors should be able to make health care decisions based on their best interest, not how it will financially benefit their doctors. The Promoting Integrity in Medicare Act is a common-sense solution to closing the self-referral loophole which will save taxpayer dollars and preserve access to quality care. “
Current law—also known as the Stark Law—bars physicians from referring Medicare patients for certain health care services in which they have a financial interest, but includes an “in-office ancillary services exception.” PIMA restores the original intent of the self-referral law by prohibiting self-referral for four complex services: advanced imaging, anatomic pathology, radiation therapy and physical therapy, which are not typically performed at the time of the patient’s initial office visit. This will ensure that incentives driving medical decisions are solely in the patients’ best interests, thereby reducing unnecessary and inappropriate services and costs to the Medicare program. PIMA will also strengthen provisions in the law that maintains access to care for rural Medicare patients.
PIMA is supported by the Alliance for Integrity in Medicare (AIM), the American Clinical Laboratory Association (ACLA), the American Physical Therapy Association (APTA), the American Society for Clinical Pathology (ASCP), the American Society for Radiation Oncology (ASTRO), the Association for Quality Imaging (AQI), the College of American Pathologists (CAP), the National Council on Aging (NCOA), the Medicare Rights Center, and the Radiology Business Management Association (RBMA).