Maryland upholds ban on in-group imaging referrals

Maryland's highest court, the Court of Appeals, has affirmed a lower court ruling that prohibits physicians from referring patients for imaging procedures conducted by members of that referring physician's group.

According to a 1993 state law, physicians in Maryland are restricted from self-referral for MRI, CT and radiotherapy. This limitation was commonly circumvented by a group practice exemption, wherein physicians would refer patients to undergo scans completed by other physicians within the referrer's group.

In 2006, however, Maryland's Board of Physicians rejected an in-group referral for an MRI scan ordered by an orthopedic surgeon. In response, 13 physician groups filed suit, including orthopedic surgeons, urologists and emergency physicians, in Potomac Valley Orthopaedic Associates, et al v. Maryland State Board of Physicians, the American Academy of Orthopedic Surgeons noted in a statement. The litigating groups claimed that the Board of Physicians had misread the self-referral statute by excluding the group exemption. The American Academy of Orthopedic Surgeons and the American College of Surgeons submitted amicus curiae briefs on behalf of the orthopedists, while the American College of Radiology (ACR) and the Maryland Radiological Society supported the Board of Physicians' decision.

On Jan. 24, the Court of Appeals affirmed the Circuit Court ruling that entitled the Board of Physicians to deference in interpreting the law, thereby upholding the law's ban on group referrals. The court looked to legislative intent in upholding the board's authority, citing the Maryland General Assembly's repeated rejection of attempts to weaken the law's reach, the ACR noted.

The court also clarified the law's "direct supervision" exception, ruling that, for "outside entities," referring physicians must be "personally present within the treatment area when the service is being performed," and must either provide or directly supervise the service.