WASHINGTON, DC – Congresswomen Jackie Speier (CA-14) and Dina Titus (NV-01) introduced legislation today to close a loophole in Medicare that is harmful to some patients and wastes billions of dollars in taxpayer funds. H.R. 2143, the Promoting Integrity in Medicare Act (PIMA) 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 a 2017 analysis conducted by the nonpartisan Congressional Budget Office (CBO).
“Too many doctors have forgotten the most important promise made in the Hippocratic Oath, ‘First, do no harm.’ Multiple GAO studies have outlined the rampant abuse and waste of more than $3 billion of taxpayer money through Medicare reimbursement for unnecessary services that are driven purely by greed for personal profit,” Rep. Speier said. “Now is the time to improve the quality and cost-effectiveness of Medicare. This bill will help get that job done by saving tax dollars and helping vulnerable seniors who depend on Medicare for their quality of life.”
“Seniors should have full confidence that their doctors are making medical decisions based on each patient’s health care needs, not the physician’s financial interests,” Rep. Titus said. “This legislation will save taxpayer dollars, strengthen Medicare, and help ensure that our seniors receive the care they deserve.”
The current law—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 which are not typically performed at the time of the patient’s initial office visit. Those four services are: advanced imaging, anatomic pathology, radiation therapy, and physical therapy. PIMA will ensure that incentives driving medical decisions are based solely on patients’ best interests, thereby reducing unnecessary and inappropriate services and costs to Medicare. 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), which is comprised of the American Clinical Laboratory Association (ACLA), the American Physical Therapy Association (APTA), the Association for Quality Imaging (AQI), the American Society for Radiation Oncology (ASTRO), the American Society for Clinical Pathology (ASCP), the College of American Pathologists (CAP), and the Private Practice Section of the American Physical Therapy Association.