Current Law and Regulations
Guidance for Section 1877 of the Social Security Act (42 U.S.C. 1395nn) which prohibits physicians from referring Medicare patients for certain designated health services (DHS) to an entity with which the physician or a member of the physician's immediate family has a financial relationship unless an exception applies.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 01, 2020
Section 1877 of the Social Security Act (42 U.S.C. 1395nn) prohibits physicians from referring Medicare patients for certain designated health services (DHS) to an entity with which the physician or a member of the physician's immediate family has a financial relationship unless an exception applies. It also prohibits an entity from presenting or causing to be presented a bill or claim to anyone for DHS furnished as a result of a prohibited referral.
In addition, section 1903(s) (42 U.S.C. 1396b) of the Social Security Act extends this referral prohibition to the Medicaid program.
The physician self-referral law can be found in section 1877 of the Social Security Act (42 U.S.C. 1395nn). The regulations are located in Title 42 of the Code of Federal Regulations §411.350 – §411.389.
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