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Sources: 42 C.F.R. §  1001.952(s)

8. Referral Arrangements for Specialty Services

Remuneration does not include any exchange of value among individuals and entities where one party agrees to refer a patient to the other party for the provision of a specialty service payable in whole or in part under Medicare, Medicaid or any other Federal health care programs in return for an agreement on the part of the other party to refer that patient back at a mutually agreed upon time or circumstance 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 individual or entity is clinically appropriate.

  2. The service for which the referral is made is not within the medical expertise of the referring individual or entity, but is within the special expertise of the other party receiving the referral.

  3. The parties receive no payment from each other for the referral and do not share or split a global fee from any Federal health care program in connection with the referred patient.

  4. Unless both parties belong to the same group practice, the only exchange of value between the parties is the remuneration the parties receive directly from third-party payors or the patient compensating the parties for the services they each have furnished to the patient.

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