Sources: 42 C.F.R. ยง 1001.952(s)

6. Specialty Referral Arrangements between Providers

Protects arrangements whereby one provider (which may be an individual or an entity) refers a specific patient to another provider, for specialty services, with the understanding that the specialty services provider will refer the patient back to the original provider at a certain time or under certain circumstances, as long as the following four standards are met:
 

  1. the mutually agreed upon time or circumstance for referring the patient back to the originating provider is clinically appropriate;

  2. the service for which the referral is made is not within the medical expertise of the referring provider, but is within the special expertise of the provider receiving the referral;

  3. the providers do not receive payment from each other for the referral and do not split a global fee from a federal health program; and

  4. the only payments either provider receives are from the patient or third-party payors for services the provider performs.

Anti-Kickback Safe Harbor