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HHS/CMS RIN: 0938-AG80 Publication ID: Fall 2000 
Title: Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships-Expanded to Designated Health Services (HCFA-1809-FC) 
Abstract: This final rule with 90-day comment period (Phase I of this rulemaking) incorporates into regulations the provisions in paragraphs (a), (b), and (h) of section 1877 of the Social Security Act (the Act). Under section 1877, if a physician or a member of a physician's immediate family has a financial relationship with a health care entity, the physician may not make referrals to that entity for the furnishing of designated health services (DHS) under the Medicare program, unless an exception applies. In addition, section 1877 of the Act provides that an entity may not present or cause to be presented a Medicare claim or bill to any individual, third party payer, or other entity for DHS furnished under a prohibited referral, nor may we make payment for a designated health service furnished under a prohibited referral. 
Agency: Department of Health and Human Services(HHS)  Priority: Other Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Long-Term Actions 
Major: Undetermined  Unfunded Mandates: No 
EO 13771 Designation: uncollected 
CFR Citation: 42 CFR 411.1    42 CFR 411.350 to 411.361    42 CFR 424.22    42 CFR 435.1002    42 CFR 435.1012    42 CFR 455.100 to 455.103    42 CFR 455.108    42 CFR 455.109   
Legal Authority: 42 USC 1302    42 USC 1395hh    42 USC 1395nn   
Legal Deadline:  None
Action Date FR Cite
NPRM  01/09/1998  63 FR 1659   
NPRM Comment Period End  05/11/1998    
Next Action Undetermined      
Regulatory Flexibility Analysis Required: Yes  Government Levels Affected: State 
Small Entities Affected: Businesses  Federalism: Undetermined 
Included in the Regulatory Plan: No 
Agency Contact:
Joanne Sinsheimer
Technical Advisor
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Medicare Management, Chronic Care Policy Group, C4-25-02, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-4620