physician self referral


Summary: Referral by physicians to testing or treatment facilities in which they have financial interest. The practice is regulated by the Ethics in Patient Referrals Act of 1989.

Top Publications

  1. Glaser D. Regulation of ancillary services. Clin Sports Med. 2002;21:305-19 pubmed
    ..If you work together, it is usually possible to structure the ancillary service in a way that can be both safe and profitable. ..
  2. Wales S. The Stark Law: boon or boondoggle? An analysis of the prohibition on physician self-referrals. Law Psychol Rev. 2003;27:1-28 pubmed
  3. Reicher M. Self-dealing in medical imaging: call for action. J Am Coll Radiol. 2007;4:202-7 pubmed
  4. Vaughn T. Anti-kickback laws. Mo Med. 2007;104:102-5 pubmed
  5. Barr P. Never surrender. Participating bonds stage comeback. Mod Healthc. 2005;35:17 pubmed
  6. Romano M. Special interests. Federation seeks change of doc self-referral laws. Mod Healthc. 2005;35:4 pubmed
  7. Kouri B, Parsons R, Alpert H. Physician self-referral for diagnostic imaging: review of the empiric literature. AJR Am J Roentgenol. 2002;179:843-50 pubmed
  8. Travis N, Chananie S, Finnegan J. The stark reality about shared nuclear medicine imaging equipment leasing arrangements after January 1, 2007. J Am Coll Radiol. 2006;3:910-3 pubmed
  9. Guglielmo W. How the new Stark rules affect you. Med Econ. 2008;85:39-42 pubmed

More Information


  1. Watts C. Stark: a legal prohibition of physician referrals. Surg Neurol. 2008;69:206-7 pubmed publisher
  2. Klepper B. When medical care is financially conflicted. MedGenMed. 2007;9:39 pubmed
  3. Terry K. Will relaxing Stark bind you tighter?. Med Econ. 2006;83:40-3 pubmed
  4. Mitchell J. Do financial incentives linked to ownership of specialty hospitals affect physicians' practice patterns?. Med Care. 2008;46:732-7 pubmed publisher
  5. Reilly P. A conflict of interest. Providers use GAO report to push for stricter legislation. Mod Healthc. 2003;33:7, 16 pubmed
  6. Blackstone E, Fuhr J. Specialty hospitals: the economics and policy issues they pose. J Health Care Finance. 2007;34:1-9 pubmed
    ..The real issue which has not been addressed is whether specialty hospitals create more value for the patient than the traditional acute care hospitals. ..
  7. Sillanaukee P, Strid N, Jousilahti P, Vartiainen E, Poikolainen K, Nikkari S, et al. Association of self-reported diseases and health care use with commonly used laboratory markers for alcohol consumption. Alcohol Alcohol. 2001;36:339-45 pubmed
    ..This general population study demonstrates that these markers, although most commonly used to assess alcohol misuse, might also serve as health risk indicators. ..
  8. Powers J, Lowry T. Recently proposed changes to physician self-referral. Mo Med. 2007;104:394-7 pubmed
  9. Le Heron J, Coakley K. CT screening--whole-body and targeted. Australas Phys Eng Sci Med. 2004;27:1-4 pubmed
    ..The ACPSEM will continue to monitor scientific studies concerning this procedure. ..
  10. Brabender V, Fallon A. Ethical hot spots of combined individual and group therapy: applying four ethical systems. Int J Group Psychother. 2009;59:127-47 pubmed publisher
    ..An analysis of three vignettes illustrates how these contrasting ethical models not only expand the range of features to which the therapist attends but also the array of solutions the therapist generates. ..
  11. Sarwar M. Self-referral: guess who is sleeping with the enemy?. J Am Coll Radiol. 2005;2:385-6 pubmed
  12. Moser J. Getting at the facts on imaging utilization growth. J Am Coll Radiol. 2005;2:720-4 pubmed
  13. Iglehart J. The uncertain future of specialty hospitals. N Engl J Med. 2005;352:1405-7 pubmed
  14. DoBias M, Robeznieks A. AHA asks IRS for help with IT. Letter requests clarification on anti-kickback rules. Mod Healthc. 2006;36:32 pubmed
  15. Fong T. Moratorium chances fading. GOP leans toward lifting limits on self-referral. Mod Healthc. 2005;35:8-9 pubmed
  16. Flizar G, Klein S, Monson R. HHS moves forward with E-prescribing standards. J Healthc Inf Manag. 2006;20:10-2 pubmed
  17. Iglehart J. The emergence of physician-owned specialty hospitals. N Engl J Med. 2005;352:78-84 pubmed
  18. Reilly P. Picking patients. GAO: specialty hospitals serve fewer uninsured. Mod Healthc. 2003;33:6-7 pubmed
  19. Beach W, Bert J, Friedman M, Glaser D. Practice management: update on coding, ancillary services, and the new Stark laws. Arthroscopy. 2002;18:53-69 pubmed
  20. Shortsleeve M, Herring W. The impact of self-referral on radiology residency training programs. J Am Coll Radiol. 2005;2:415-7 pubmed
    ..Self-referral endangers the quality of radiology residencies. The authors discuss strategies to protect radiology residency programs. ..
  21. Szabo J. Stark II rules and labs; lab fee rates overhaul. MLO Med Lab Obs. 2002;34:60 pubmed
  22. Conn J. Looking for a helping hand. Despite recent federal guidance on IT subsidies for docs, not-for-profits still skittish. Mod Healthc. 2007;37:38, 40-1 pubmed
  23. Wright W. Nuclear options: why there will be a fire sale on nuclear imaging equipment in 2006. Tenn Med. 2006;99:31-2 pubmed
  24. Giordano J. Physicians, payments, and practices: moral issues, public perceptions, and the Stark laws. Pain Physician. 2007;10:719-23 pubmed
  25. Welch S, Burgar J, Mylnar M. Stark III: what does it mean for me?. J Med Assoc Ga. 2008;97:27-30 pubmed
  26. Williams K. The new era of medical imaging. N Engl J Med. 2006;355:1502 pubmed
  27. Kahn C. Caveat emptor: joint ventures with specialty hospitals. Healthc Financ Manage. 2006;60:90-4 pubmed
    ..Hopitals can best serve the interests of patients and improve performance by building enduring partnerships with physicians. ..
  28. Bristol N. Physician-owned specialty hospitals in the USA. Lancet. 2005;366:193-4 pubmed
  29. Roeder K, Jalo V. Ambulatory surgery center proposals bring mixed response from OIG. GHA Today. 2003;47:3, 8 pubmed
  30. Swartzmeyer S, Killoran C. Specialty hospital ban was premature. Studies would have shown whether those facilities help or harm healthcare. Mod Healthc. 2004;34:21 pubmed
  31. Becker C. Imaging imbroglio. Battle over self-referrals is pitting doc against doc. Mod Healthc. 2004;34:16 pubmed
  32. Borges W. The Stark truth. Government tries to make sense of long and complex law. Tex Med. 2004;100:37-8 pubmed
  33. Goran M, Fuller E. Navigating the minefield: legal ethics and healthcare law. J Health Law. 2002;35:359-85 pubmed
    ..The authors conduct their analysis by applying the model rules to a number of hypothetical fact situations typical of those encountered in the day-to-day practice of healthcare law. ..
  34. Bennett L. The next steps. BMJ. 2003;326:S103 pubmed
  35. Gabel J, Fahlman C, Kang R, Wozniak G, Kletke P, Hay J. Where do I send thee? Does physician-ownership affect referral patterns to ambulatory surgery centers?. Health Aff (Millwood). 2008;27:w165-74 pubmed publisher
    ..Findings indicate that physicians at physician-owned facilities are more likely than other physicians to refer well-insured patients to their facilities and route Medicaid patients to hospital outpatient clinics. ..
  36. Murer C. Here's to good news. Rehab Manag. 2003;16:44-5 pubmed
  37. Leiker M. Stark phase III regulations take effect December 4, 2007. WMJ. 2007;106:501-3 pubmed
  38. Greene J. Star search. In-town recruiting of top docs is once again in vogue as hospitals take advantage of regulations that clearly define what's allowed. Mod Healthc. 2006;36:70, 72 pubmed
  39. Pursell D, Marsh J, Thompson D, Potter K. Stark II and physician compensation models: integrating business and legal issues. J Health Law. 2005;38:45-76 pubmed
    ..the Centers for Medicare & Medicaid Services released new regulations that interpreted the Federal Physician Self Referral Act, otherwise known as Stark II...
  40. Levin D, Rao V. Turf wars in radiology: other causes of overutilization and what can be done about it. J Am Coll Radiol. 2004;1:317-21 pubmed
    ..It is important for radiologists to be familiar with these issues and to support efforts to control overutilization. ..
  41. Reynolds M. Stark realities for hospitals. Healthc Financ Manage. 2004;58:50-5 pubmed
    ..Providers need to understand the principal changes in each category and modify their compliance efforts when compensating physicians. ..
  42. Bateman C. Small mercies for 'outfoxed' surgeons. S Afr Med J. 2004;94:732, 734 pubmed
  43. Johnson B. Stark II, phase II. What it means for physician compensation. MGMA Connex. 2004;4:43-8, 1 pubmed
    ..The rules codify common-sense ideas that physicians can receive direct compensation for their labor and for the financial success of their group practices. ..
  44. Gearon C. Legislation. A different niche?. Hosp Health Netw. 2004;78:16, 18 pubmed
  45. Fong T. Sympathetic ears. Legislators agree with acute-care hospitals' stance. Mod Healthc. 2005;35:8-9 pubmed
  46. Harris J. The new Stark Phase II rules. Bull Am Coll Surg. 2004;89:8-11 pubmed
  47. Levin D, Rao V. Turf wars in radiology: the overutilization of imaging resulting from self-referral. J Am Coll Radiol. 2004;1:169-72 pubmed
    ..The authors estimate that the cost to the American health care system of unnecessary imaging resulting from self-referral by nonradiologists is $16 billion per year. ..
  48. Mustokoff M, Nelson C. The False Claims Act: the courts move toward a rule of reason. J Med Pract Manage. 2005;20:317-22 pubmed
    ..It indicates the limitations that are imposed on prosecutors, as well as the liability that providers do incur under current statues. ..
  49. Gosfield A. The Stark truth about the Stark law: Part II. Fam Pract Manag. 2004;11:41-5 pubmed
  50. Cronan J. DEFCON one! Imaging under attack. J Am Coll Radiol. 2005;2:207-10 pubmed
  51. Levin D, Rao V. Turf wars in radiology: possible remedies for self-referral that could be taken by federal or state governments and payers. J Am Coll Radiol. 2004;1:806-10 pubmed
  52. Miller J. Scanning for dollars. Joint ventures in imaging. MGMA Connex. 2003;3:52-5, 1 pubmed
    ..Unless an imaging joint venture is both financially and legally feasible, it's not worth doing. ..
  53. Hendee W, Becker G, Borgstede J, Bosma J, Casarella W, Erickson B, et al. Addressing overutilization in medical imaging. Radiology. 2010;257:240-5 pubmed publisher