Ethics in Referrals and Billing Act of 1992

Summary

Ethics in Referrals and Billing Act of 1992 - Amends the Public Health Service Act to create a new title on physician referral and billing. Prohibits, subject to exceptions, referrals and related billing by physicians involving an entity in which the physician (or an immediate family member) has a financial relationship. Requires each entity providing health-related items or services to disclose certain information concerning the entity's ownership. Declares that no individual, entity, or third party payor shall be required to pay for items or services in connection with a prohibited referral. Makes any person collecting such payments liable to the payor. Requires insurance payors to report violation patterns. Provides for civil fines for persons repeatedly presenting bills, physicians repeatedly making referrals, and persons acting in concert in violation. Allows for violations: (1) suspension, revocation, or limitation of laboratory certificates; and (2) exclusion from any program under title XVIII (Medicare) of the Social Security Act. Makes it unlawful, subject to exception, for any: (1) person who furnishes ancillary health services to present a bill to any person other than the patient receiving the services; or (2) physician to present a bill to any ancillary service recipient unless the services where furnished personally or under the supervision of the referring physician or a member of that physician's group practice or by individuals employed by that physician or group practice. Makes any person collecting payments for such services liable to the payor. Provides for civil fines for persons repeatedly presenting bills in violation. Allows, for violations: (1) suspension, revocation, or limitation of laboratory certificates; and (2) exclusion from any pogram under Medicare.

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2 official files

• Introduced in Senate (text)

  Introduced in Senate · EN

  ViewDownloadOpen at official source

• Introduced in Senate

  summary · EN · 12 August 1992

  Open at official source

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