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House Committee on Energy and CommerceHealthHouse Committee on Ways and MeansIntroducedAugust 1st, 2013
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Promoting Integrity in Medicare Act of 2013
To prevent abusive billing of ancillary services to the Medicare program, and for other purposes.
Promoting Integrity in Medicare Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act (SSA) with respect to the general exceptions to both ownership and compensation arrangement prohibitions against physician self-referrals of Medicare patients to the entity with which a physician has a certain financial relationship. Removes from the in-office ancillary services (IOAS) exception to such prohibitions certain services the Secretary of Health and Human Services (HHS) determines are not usually provided and completed during the visit to a physician's office in which such a service is determined to be necessary (non-ancillary services). (Thus subjects such non-ancillary services to the prohibitions against physician self-referrals). Lists among specified non-ancillary services: (1) anatomic pathology services (including the technical or professional component of surgical pathology, cytopathology, hematology, blood banking, and pathology consultation and clinical laboratory interpretation services), (2) radiation therapy services and supplies, (3) advanced diagnostic imaging studies, and (4) physical therapy services. Increases from a maximum of $15,000 to a maximum of $25,000 the civil monetary penalty in the case of a bill or claim for such services whose presenter knows or should have known they are for a service for which payment may not be made. Increases from a maximum of $100,000 to a maximum of $150,000 the civil monetary penalty for any circumventive arrangement or scheme which a physician or other entity enters into knowing (or should know) has a principal purpose of assuring referrals by the physician to a particular entity which, if the physician directly made referrals to such entity, would be in violation of SSA title XVIII. Directs the Secretary to review compliance with the self-referral prohibitions with respect to referrals for specified non-ancillary services in accordance with procedures established by the Secretary. States that, in applying the self-referral prohibitions, the term "entity" includes a physician's practice when it bills under Medicare for the technical component or the professional component of a specified non-ancillary service.