On April 9, 2019, new legislation was proposed in the House to update Medicare policies currently in place under the Stark Law. The Stark Law bars physicians from referring Medicare patients for certain health care services in which they have a financial interest but includes an “in-office ancillary services exception.” This proposed bill, H.R.2143, also known as “Promoting Integrity in Medicare Act of 2019” or “PIMA of 2019” was introduced by Representatives Jackie Speier (D-California) and Dina Titus (D-Nevada) and aims to close the “loophole” by preventing self-referrals for advanced imaging services, radiation therapy, anatomic pathology, and physical therapy.

According to an analysis conducted by the Congressional Budget Office (CBO), closing this loophole would save an estimated $3.3 billion.  According to Rep. Speier, PIMA restores the original intent of the self-referral law by prohibiting self-referral for four complex services which are not typically performed at the time of the patient’s initial office visit. Those four services are: advanced imaging, anatomic pathology, radiation therapy, and physical therapy. PIMA will ensure that incentives driving medical decisions are based solely on patients’ best interests, thereby reducing unnecessary and inappropriate services and costs to Medicare. PIMA will also strengthen provisions in the law that maintains access to care for rural Medicare patients.

PIMA is supported by The Alliance for Integrity in Medicare (AIM), which is comprised of the American Clinical Laboratory Association (ACLA), the American Physical Therapy Association (APTA), the Association for Quality Imaging (AQI), the American Society for Radiation Oncology (ASTRO), the American Society for Clinical Pathology (ASCP), the College of American Pathologists (CAP), and the Private Practice Section of the American Physical Therapy Association.

Again, this is a proposed bill. According to GovTrack, there is a predicted 4% chance that this bill will become law. Also, it’s important to note similar bills have been proposed in earlier Congresses (2016 and 2017) without success.

As always, ADVOCATE will keep you up to date on this and all issues impacting radiology as they become available.


Lauren Sloan, MHA, RD, LD

Director of Regulatory Affairs