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Is it illegal to refer a patient to another health care provider?

On Behalf of | Feb 29, 2024 | Healthcare Fraud

As a physician, you give your patients the best care possible. When their medical condition falls out of your scope of expertise, you would want to refer them to another specialist or health care provider better suited to address their specific health concerns. You would not want to refer your patient to someone you do not know.

Referring a patient to another health care provider is perfectly legal, but there are situations where the intent and details of the referral process could come under scrutiny.

A referral can trigger a federal investigation

You might wonder why there would be any legal question about referring your patient to another doctor you know and trust. The Stark Law and the Anti-Kickback Statute are two federal laws that govern these situations, particularly when programs such as Medicare and Medicaid are involved. These laws aim to prevent health care fraud and abuse. To ensure you are legally referring your patient to another health care provider, you must ensure the following:

  • The provider you are referring the patient to is qualified and able to provide the necessary care and treatment.
  • You made the referral in your patient’s best interests, not for personal gain.

You should avoid referring patients to providers with whom you have a personal or financial relationship unless exceptions apply. Legitimate arrangements that serve a patient’s best interests without leading to overutilization or increased costs to federal health care programs are legal. Still, you must comply with relevant regulations and requirements when making such referrals.

Referrals become problematic and potentially illegal when a physician does them in exchange for kickbacks or financial gain. If your intention was to give your patient the best health care available, it is not a crime.