107 STAT. 596 PUBLIC LAW 103-66 —AUG. 10, 1993 October 1, 1989, to any claims that the Secretary of Health and Human Services had not identified as of that date as subject to the provisions of section 1862(b) of such Act. SEC. 13562. PHYSICIAN OWNERSHIP AND REFERRAL. (a) IN GENERAL.— Section 1877 (42 U.S.C. 1395nn) is amended— (1) by amending subsections (a) through (e) to read as follows: "(a) PROHIBITION OF CERTAIN REFERRALS.— "(1) IN GENERAL.—Except as provided in subsection (b), if a physician (or an immediate family member of such physician) has a financial relationship with an entity specified in paragraph (2), then— "(A) the physician may not make a referral to the entity for the fimiishing of designated health services for whicn payment otherwise may be made under this title, and "(B) the entity may not present or cause to be presented a claim under this title or bill to any individual, third party payor, or other entity for designated health services fiimished pursuant to a referral proMbited under subparagraph (A). "(2) FINANCIAL RELATIONSHIP SPECIFIED.— For purposes of this section, afinancialrelationship of a physician (or an immediate family member of such physician) with an entity specified in this paragraph is— "(A) except as provided in subsections (c) and (d), an ownership or mvestment interest in the entity, or "(B) except as provided in subsection (e), a compensation arrangement (as defined in subsection (h)(D) between the physician (or an immediate family member of such physician) and the entity. An ownership or investment interest described in subparagraph (A) may be uirough equity, debt, or other means and includes an interest in an entity that holds an ownership or investment interest in any entity providing the designated health service, (b) GENERAL EXCEPTIONS TO BOTH OWNERSHIP AND COMPENSA- TION ARRANGEMENT PROHmmoNS.— Subsection (a)(1) shall not apply in the following cases: "(1) PHYSICIANS' SERVICES.— In the case of physicians' services (as defined in section 1861(q)) provided personally by (or under the personal supervision of) another physician in the same group practice (as defined in subsection (h)(4)) as the referring physician. "(2) IN-OFFICE ANCILLARY SERVICES. — In the case of services (other than durable medical equipment (excluding infiision pumps) and parenteral and enteral nutrients, equipment, and supplies)— "(A) that are fiimished—
- (i) personally by the referring physician, personally by a physician who is a member of the same
group practice as the referring physician, or personsdly by individuals who are directly supervised by the physician or by another physician in the group practice, and
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