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Conflicts of Interest, Continued-Reply

E. Haavi Morreim, PhD
JAMA. 1990;263(9):1200. doi:10.1001/jama.1990.03440090029017.
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In Reply.—  Although federal anti-kickback laws and the Inspector General's "safe harbor" guidelines apply to both Medicare and Medicaid, Rep Fortney Stark's bill does not. While my first mention of the bill (p 390) is limited to Medicare, the cited passage (p 391) wrongly adds Medicaid.Common law has not yet addressed physician investment and self-referral to ancillary facilities for the same reason that we do not yet have final legislation: the phenomenon itself is new, as recent cost-containment programs shift more care to outpatient settings and increasingly focus on physicians' incomes.1Abusive self-referral does cause injuries. Aside from the obvious harms of money wasted on needless and possibly iatrogenic tests or treatments, the deeper injury may be to the patient's trust when he or she discovers that the magnetic resonance imaging scan received at 2 AM could have been done more conveniently and less expensively by an identical,


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