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When is it appropriate to refer patients to other family members?

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  • When is it appropriate to refer patients to other family members?

    If you are practicing in a certain area and another family member is in town who is one of only 2-3 specialists in a large radius, is it appropriate to refer to them? Do you just provide a list of all providers for that specialty including your family member? would you specifically avoid referring to the family member and only refer to the other guy in order to avoid appearing to be in violation of some law?

    If yes to the third question, are you referring to stark law? start law doesn't seem to specifically apply to this question, as in this scenario, you don't stand to benefit financially from your referral to the family member.

  • #2
    there's certainly no federal law forbidding you to treat family members. A lot of states have guidelines/recommendations, usually issued by the state medical boards. My state doesn't have any rules about treating yourself/writing rx's for yourself, much less family members, other then a recommendation against it when possible. I think that the only way that you would get into trouble is if you were writing controlled substances, or billing for unnecessary services. I think that some insurers have rules against billing family members so you might need to look into that. I don't think that there is any medicare rule against it though.

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    • #3
      Originally posted by nephron View Post
      there's certainly no federal law forbidding you to treat family members. A lot of states have guidelines/recommendations, usually issued by the state medical boards. My state doesn't have any rules about treating yourself/writing rx's for yourself, much less family members, other then a recommendation against it when possible. I think that the only way that you would get into trouble is if you were writing controlled substances, or billing for unnecessary services. I think that some insurers have rules against billing family members so you might need to look into that. I don't think that there is any medicare rule against it though.
      Thank you, however not my question. my question was regarding REFERRING a patient to another family member.

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      • #4
        I wouldn't hesitate to do it but I also would definitely make it known to the patient what the situation is. If they find out later that might be awkward especially if there's trouble. but I think you need to honestly do what is right for your patience and if your family member is the right person for the job I do not think they should be ignored. Obviously if you're getting some sort of kick back then this is a big problem. But it does not sound like this is the case.

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        • #5
          I don't think the Stark Law is a factor unless your family member is giving you a kickback, which is a problem whether he's your family member or not. I would tell the patient that the specialist is your relative, though.

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          • #6
            if you do what's medically the best for your patient (and documented as such) then the state med board will not care. if you are getting kickbacks for referrals, regardless of if they are your family, then you will be in trouble.
            hospital systems may have different guidelines you need to watch out for if you are hospital employed
            It's psychosomatic. You need a lobotomy, I'll get a saw.

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            • #7
              Nothing wrong with it. Just disclose your potential conflict of interest and be open. If you start hearing complaints or suspect your family member's medical practice is below standard of care, then you'd have an ethical responsibility not to refer them. But for the most part, it shouldn't be a big deal. I wouldn't really mind if my pcp referred me to his brother surgeon or whatever as long as I knew.

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              • #8
                One thing I've wondered about is what you do with a husband/wife situation. For example if one spouse refers to another spouse even though they are not receiving a kickback of any kind (in the way the term is normally used), all the money goes to the same place. Is that enough to make it a Stark violation?

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                • #9
                  When is a referral to a family member inappropriate?
                  That’s easier to answer. You are making the referral in the best interest of the patient aren’t you?
                  If your spouse or relative is the best colorectal surgeon, you can bet I would kick your a$$ sending me to someone else. Better yet, can you text em and get em to see me in 30? This is real PITA. Done.

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                  • #10
                    I agree with Tim. Not referring to whom you think it "best" could be twisted into malpractice/negligence.

                    Anytime I do/say something that I think may be held in doubt, I tell patients "if you were my parent/sibling I'd (try the injection / go see an eyelash surgeon / have an MRI)"

                    If they receiving entity held some relation to me, I'd simply tell the patient "but to be fair, that eyelash surgeon is my step half 6 times removed 3rd cousin, so feel free to check with another eyelash surgeon". I'd certainly document it as well.
                    "Oh look another bajillion point declin-Ooooh!!! A coupon for pizza!!!!" <--- This is what everyone's IPS should be. ✓✓✓

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                    • #11
                      Originally posted by Cubicle View Post
                      I agree with Tim. Not referring to whom you think it "best" could be twisted into malpractice/negligence.

                      Anytime I do/say something that I think may be held in doubt, I tell patients "if you were my parent/sibling I'd (try the injection / go see an eyelash surgeon / have an MRI)"

                      If they receiving entity held some relation to me, I'd simply tell the patient "but to be fair, that eyelash surgeon is my step half 6 times removed 3rd cousin, so feel free to check with another eyelash surgeon". I'd certainly document it as well.
                      When you say document it, you mean document that you told them it was your relative, or that you offered them multiple referral choices

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                      • #12
                        "Patient given contact information of eyelash surgeon, but patient told eyelash surgeon is of relation to myself & urged to seek an independent eyelash surgeon if patient has any concerns."
                        "Oh look another bajillion point declin-Ooooh!!! A coupon for pizza!!!!" <--- This is what everyone's IPS should be. ✓✓✓

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                        • #13
                          Stark is crystal clear on this. No external referrals to a family member (or anyone with whom a family member has a financial relationship such that they benefit from the business) on Medicare/Medicaid patients. Period. I deal with this routinely. Family member in related specialty with lots of back and forth referrals. Family member's group is the only group in a 100+ mile radius that accepts Medicare. There's literally nobody else they can see. However, even sending a referral to another partner in the group is a violation because my family member has an ownership interest in the group as a whole. Best I can do is say, "I recommend you get an evaluation and here's why. This is who I recommend. Medicare rules don't allow me to send a referral myself because my family member works there. Feel free to self refer or ask your PCP. Of course, I'll share my records."

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                          • #14
                            Originally posted by pulmdoc View Post
                            Stark is crystal clear on this. No external referrals to a family member (or anyone with whom a family member has a financial relationship such that they benefit from the business) on Medicare/Medicaid patients. Period. I deal with this routinely. Family member in related specialty with lots of back and forth referrals. Family member's group is the only group in a 100+ mile radius that accepts Medicare. There's literally nobody else they can see. However, even sending a referral to another partner in the group is a violation because my family member has an ownership interest in the group as a whole. Best I can do is say, "I recommend you get an evaluation and here's why. This is who I recommend. Medicare rules don't allow me to send a referral myself because my family member works there. Feel free to self refer or ask your PCP. Of course, I'll share my records."
                            right so as long as it’s not a physical or electronic referral slip, recommending the fam member is ok just don’t write down the family members name in the chart and tell them to get a pcp referral if needed by insurance.

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                            • #15
                              Originally posted by pulmdoc View Post
                              Stark is crystal clear on this. No external referrals to a family member (or anyone with whom a family member has a financial relationship such that they benefit from the business) on Medicare/Medicaid patients. Period. I deal with this routinely. Family member in related specialty with lots of back and forth referrals. Family member's group is the only group in a 100+ mile radius that accepts Medicare. There's literally nobody else they can see. However, even sending a referral to another partner in the group is a violation because my family member has an ownership interest in the group as a whole. Best I can do is say, "I recommend you get an evaluation and here's why. This is who I recommend. Medicare rules don't allow me to send a referral myself because my family member works there. Feel free to self refer or ask your PCP. Of course, I'll share my records."
                              Thanks this is helpful. So let me ask you about a couple of scenarios.

                              1. X and Y are married docs. Both are employees (i.e., no ownership) in different practices. Y is in a subspecialty that X often needs to refer to. Is it a Stark violation if X refers to Y?

                              2. X and Y are married docs. Both are employees (i.e., no ownership) in different practices. Y is in a subspecialty that X often needs to refeer to. Is it a Stark violation if X refers to Z who works in the same office as Y and practices the same specialty?

                              For both of the questions above, if it is a Stark violation, are you saying the referral is OK if the patient is not a Medicare/Medicaid patient?

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