The Maryland Board of Physicians took steps this week to enforce the recently upheld Self-Referral Law for MRI and CT scans by mailing letters to all physicians who may be in violation of the statute.

According to the statement issued by the Board, the letters were to be mailed on March 1 and would request the physicians to provide within 10 business days current information about the practice, ownership in both the practice and MRI equipment and whether the doctor refers patients to practice-owned MRI equipment.

It is unclear how many physicians would be affected by the enforcement as officials at the Maryland Board of Physicians would not comment on how many letters were mailed.
"Anything related to an investigation is confidential by law in Maryland, and all of the files are confidential and cannot be disclosed," said Karen Wulff, a policy analyst with the Board.

The Self-Referral Law, which was initially enacted in 1993 and upheld by the Maryland Court of Appeals in January , makes it illegal to refer a patient for an MRI scan on equipment in which the referring physician has a financial interest.

"It is our intention to enforce the law. Our intention is to put people on notice, both patients and practitioners, that if there is a self-referral practice out there, it needs to be stopped," said Board chairman Paul T. Elder, in an interview with the Washington Post this week.

In a statement, the Board said the Self-Referral Law "does not distinguish between the provision of radiation therapy services, magnetic resonance imaging services and computer tomography scan services."

The issue has been widely debated in the industry, as the number of doctor-owned centers offering radiation therapy has increased in recent years. While those physicians who have purchased their own MRI machines say they are providing a convenient access to experts and treatment, critics argue that the trend of these self-referrals is exploitive.

For those physicians who receive a letter from the Board, they are expected to act swiftly to reverse course. Physicians who are found in violation of the law will be asked to cease self-referrals within 60 days.

The Board's decision to enforce the law can potentially have a significant impact on the Maryland health care community. According to reports, the state ranks second in the nation, behind Florida, in the number of MRI tests per capita reimbursed by Medicare. Nationwide the number of MRI machines owned by non-radiologists has also skyrocketed, rising 245 percent from 2000 to 2005, according to The Baltimore Sun, citing data from the Center for Research on Utilization of Imaging Services at Thomas Jefferson University.

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