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Despite Some Overlap, Ethical and Legal Issues of Physician Self-referral Remain Distinct

Teri Randall
JAMA. 1991;266(17):2335. doi:10.1001/jama.1991.03470170019004.
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THE ETHICAL issues of physician self-referral are somewhat distinct from the legal issues.

But they do overlap, because the medical profession's code of ethics demands that physician investors comply with the law. Beyond this, however, there are separate considerations that determine whether a physician's investment in a medical facility is ethical.

Legal analysts say that the new safe harbor regulations are guideposts, but are not the final word legally or ethically. A joint venture outside the safe harbors, for example, may or may not be legal, depending on its intent. (Please see accompanying article.)

So, too, a joint venture outside of these safe harbors regulations may or may not be considered ethical.

Incentives to Refer?  Kirk Johnson, JD, general counsel of the American Medical Association (AMA), says that, in theory, physician joint ventures may have 100% ownership by referring physicians and still be ethical, provided certain conditions are met.Likewise,


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