Court: Non-radiologists can't refer for in-office imaging

The debate over Maryland's self-referral law heads to an appeals court where another trial court ruling could play a role.

By Amy Lynn Sorrel, AMNews staff. Dec. 17, 2007.

A trial court ruling has Maryland physicians dueling over the scope of the state's self-referral law regarding in-office imaging tests and services.

Mirroring federal "Stark" laws, Maryland prohibits doctors from referring patients to diagnostic entities in which they have a financial stake, except in certain circumstances.

Despite some of those exceptions, though, the Montgomery County Circuit Court said Oct. 18 the 1993 statute strictly bans non-radiologists from referring patients within their practices for CT, MRI and radiation therapy services. The decision affirms similar interpretations made by the Maryland Board of Physicians and the state attorney general in 2006 and 2004, respectively.

The court battle ensued when a group of 14 medical practices challenged the board last December. The plaintiffs -- comprising orthopedic surgeons, urologists and emergency physicians -- are part of the Maryland Patient Care and Access Coalition, which was formed to advocate for the issues at stake in the case. The doctors say state authorities misread the law and several exemptions within it that allow in-office referrals for ancillary services, including imaging tests.

The trial court disagreed, focusing on a seeming conflict between several provisions in the law.

Judge DeLawrence Beard recognized three exemptions when doctors are permitted to self-refer. They are:

• The doctor is referring for in-office ancillary services that meet certain supervision, location and billing requirements.