I 
113TH CONGRESS 
1ST SESSION H. R. 2914 
To prevent abusive billing of ancillary services to the Medicare program, 
and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
AUGUST 1, 2013 
Ms. SPEIER (for herself, Ms. TITUS, and Mr. MCDERMOTT) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To prevent abusive billing of ancillary services to the 
Medicare program, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Promoting Integrity 
in Medicare Act of 2013’’. 
SEC. 2. FINDINGS; PURPOSES. 
(a) FINDINGS.—Congress finds the following: 
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(1) Recent studies by the Government Account-
ability Office (GAO) examining self-referral practices 
in advanced diagnostic imaging and anatomic pa-
thology determined that financial incentives were the 
most likely cause of increases in self-referrals. 
(2) For advanced diagnostic imaging, GAO 
stated that ‘‘providers who self-referred made 
400,000 more referrals for advanced imaging serv-
ices than they would have if they were not self-refer-
ring’’, at a cost of ‘‘more than $100 million’’ in 
2010. 
(3) For anatomic pathology, GAO found that 
‘‘self-referring providers likely referred over 918,000 
more anatomic pathology services’’ than they would 
have if they were not self-referring, costing Medicare 
approximately $69 million more in 2010 than if self- 
referral was not permitted. 
(4) Noting the rapid growth of services covered 
by the in-office ancillary services (IOAS) exception 
and evidence that these services are sometimes fur-
nished inappropriately by referring physicians, the 
Medicare Payment Advisory Commission (MedPAC) 
stated that physician self-referral of ancillary serv-
ices creates incentives to increase volume under 
Medicare’s current fee-for-service payment systems 
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and the rapid volume growth contributes to Medi-
care’s rising financial burden on taxpayers and bene-
ficiaries. 
(5) According to the Centers for Medicare & 
Medicaid Services, a key rationale for the IOAS ex-
ception was to permit physicians to provide ancillary 
services in their offices to better inform diagnosis 
and treatment decisions at the time of the patient’s 
initial office visit. 
(6) It is necessary, therefore, to distinguish be-
tween services and procedures that were intended to 
be covered by the IOAS exception, such as routine 
clinical laboratory services or simple x-rays that are 
provided during the patient’s initial office visit, and 
other health care services which were clearly not en-
visioned to be covered by that exception because they 
cannot be performed during the patient’s initial of-
fice visit. 
(7) According to a 2010 Health Affairs study, 
less than 10 percent of CT, MRI, and Nuclear Medi-
cine scans take place on the same day as the initial 
patient office visit. 
(8) According to a 2012 Health Affairs study, 
urologists’ self-referrals for anatomic pathology serv-
ices of biopsy specimens is linked to increased use 
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and volume billed along with a lower detection of 
prostate cancer. 
(9) According to an October 2011 Laboratory 
Economics report, there has been an increase in the 
number of anatomic pathology specimen units billed 
to the Medicare part B program from 2006 through 
2010, specifically for CPT Code 88305, and the rate 
of increase billed by physician offices for this service 
is accelerating at a far greater pace than the rest of 
the provider segments. 
(10) According to a 2013 American Academy of 
Dermatology Pathology Billing paper, arrangements 
involving the split of the technical and professional 
components of anatomic pathology services among 
different providers may endanger patient safety and 
undermine quality of care. 
(11) In November 2012, Bloomberg News re-
leased an investigative report that scrutinized or-
deals faced by California prostate cancer patients 
treated by a urology clinic that owns radiation ther-
apy equipment. The report found that physician self- 
referral resulted in a detrimental impact on patient 
care and drove up health care costs in the Medicare 
program. The Wall Street Journal, the Washington 
Post, and the Baltimore Sun have also published in-
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