Maryland State Self-referral Law
Maryland
As a background, the Maryland Self-Referral Law (Md. HEALTH OCCUPATIONS Code Ann. § 1-301 et seq.), enacted in 1993, prohibited non-radiologists from referring patients for MRI, CT, and radiation therapy on machines within their practices or practice groups. The law remained largely unenforced until 2006 when the Maryland Board of Physicians issued an interpretation of the 1993 statute against the practice of self-referral. Thirteen physician groups filed a lawsuit (Potomac Valley Orthopedic Associates, et al. v. Maryland State Board of Physicians) with the Circuit Court in opposition to the Board’s ruling, claiming that the Board misinterpreted the General Assembly’s intent.
In early 2007, the MRS intervened as party-defendant, urging the court to uphold the Board’s ruling as a valid interpretation of state law. At that time, the ACR provided policy arguments and utilization data that the MRS included in its brief. Joining the opposition in amicus were the American Association of Neurological Surgeons, Society of Cardiovascular Computed Tomography, Mid-Maryland Musculoskeletal Institute, American Urological Association, Inc., and the American College of Surgeons.
After the Circuit Court ruled in favor of the Maryland Board of Physicians, self-referring physicians immediately filed an appeal. The Court of Appeals, Maryland’s highest court, heard oral arguments on the case in October of 2008. On January 21, 2011, the Court of Appeals upheld the lowest court’s decision in favor of Maryland Board of Physicians hence ruling against the appellant orthopedic practices. Court’s opinion.
Coverage in the media:
Medical Imaging War Pits Doctor vs. Doctor
Orthopedist-owned MRIs a recipe for soaring costs
As anticipated, the law is being challenged legislatively.
SB 808 (HB782) Health Occupations - Imaging and Radiation Therapy Services - Accreditation
Altering the definition of "in-office ancillary services" as it relates to specified referrals by health care practitioners so as to exclude magnetic resonance imaging services, computed tomography scan services, and radiation therapy services unless specified conditions are met; altering specified exceptions to patient referral prohibitions; requiring specified health care entities that provide specified services on or after January 1, 2012, to be accredited by specified organizations; etc.
