Maryland Board of Physicians Boosts State Self-referral Law
Maryland’s anti-referral law received a vital endorsement from a key stakeholder. The Maryland Board of Physicians, which is charged with enforcing the statute, recently ruled that numerous financial arrangements involving non-radiologists violate the law. Considered a pioneer of state self-referral laws, the Maryland statute survived a major challenge to the law itself and its enforcement. Additionally, the Board decisively rejected the “patient convenience” position advanced by self-referral advocates.
Last year, 15 groups of specialty physicians, including orthopedists and neurologists, sued the Board to invalidate the State Attorney General’s recent interpretations of the 1993 law. The plaintiffs claimed that because the AG determined certain arrangements involving specialists self-referring for in-office MR and CT scans violated the Maryland law, some payers demanded refunds from those physicians. However, the court ultimately dismissed the case after the plaintiffs agreed with the Board to drop the lawsuit. The plaintiffs also asked the Board for a declaratory ruling on the legality of various MR referral arrangements.
The Board analyzed arrangements in which orthopedic and neurologic group practices both received outside referrals for MR studies from other practitioners and referred for those studies within their own groups. In each case, the Board found that the specialists stood to benefit financially from self-referring for the scans. The Board concluded that such arrangements did not meet any applicable exception and thus violated the Maryland law. The Board ruled, though, that referrals from employed physicians may or may not be illegal, depending on the particular arrangement.
Notably, the Board dismissed the argument self-referral advocates have made that patients benefit from having the “convenience” of in-office MR studies. The Board emphasized that none of the patients in the cases it examined had an MR on the same day that they visited a specialist, and many of the studies occurred in different offices than where they were first seen. Although the Board did not study the issue in depth, it found that self-referred MRs did not appear to offer more convenience than non-self-referred MRs.
The declaratory ruling can help to serve not only future attempts to uphold the Maryland anti-referral law, but it can also help other state societies as they move forward to introduce anti self-referral legislation. The logic and evidence used to dismiss the “convenience” argument can be utilized in conjunction with state and federal advocacy as state societies and the ACR continue to advocate for the appropriate utilization of diagnostic imaging. For a full copy of the declaratory ruling, please contact Ariel González, Assistant Director of State Legislative Relations at agonzalez@acr.org.