Congress should take up H.R. 2066

March 22, 2018
It has now been a year since H.R. 2066—the Promoting Integrity in Medicare Act of 2017 (PIMA)—was introduced in the U.S. House of Representatives by Rep. Jackie Speier (D-CA). On April 6, 2017, Rep. Speier offered the bill, which would end the physician self-referral loophole in the so-called Stark Law (“Ethics in Patient Referrals Act”), which was originally passed in 1989, refined in budget reconciliation laws in the 1990s, and implemented in stages by the Centers for Medicare and Medicaid Services in the first decade of this century.

The Stark Law prohibits physicians from referring Medicare patients to clinical labs in which the physician has a financial interest, but it has a number of exceptions, ostensibly for same-day in-office ancillary services. The exceptions have been stretched to include imaging, physical therapy, radiation treatments for cancer, and anatomic pathology services. That has circumvented the intention of the Law.

The PIMA legislation, sponsored by Rep. Speier and co-sponsored by Reps. Dina Titus (D-NV) and Ro Khanna (D-CA), is formally known as “H.R. 2066: To prevent abusive billing of ancillary services to the Medicare program, and for other purposes.” The part of the bill dealing with anatomic pathology refers to the Government Accounting Office’s (GAO) finding that “‘self-referring providers likely referred over 918,000 more anatomic pathology services’ than they would have if they were not self-referring, costing Medicare approximately $69,000,000 more in 2010 than if self-referral was not permitted.”

The legislative history of the PIMA Act, which can be reviewed at, does not take long to summarize: On the day of its introduction, the bill was “referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.” The next day, April 7, 2017, the Committee on Energy and Commerce referred it to the Subcommittee on Health; two weeks later, on April 21, 2017, the Ways and Means Committee did the same.

And there it sits, as of now. This is what we mean when we say that a bill “died in committee.”

Not that the bill lacks supporters. Laboratory organizations, as well as some stakeholders related to delivery of the other “ancillary services” affected by the misuse of the exceptions to Stark, have been outspoken in support of PIMA. Strong arguments can be made that H.R. 2066 would retain the in-office ancillary services exception where appropriate but remove inappropriate applications; protect patients from receiving treatment or testing that is not really needed but is recommended based on, shall we say, financial incentives available to ordering physicians; and save billions of dollars for the Medicare program.

The arguments against PIMA are harder to imagine, though I’m sure there are reasonable ones. I will assume that there is a legitimate case that could be made, that opponents are not motivated simply by an ignoble desire to protect unethical physicians. But by bottling up the bill in committee, House leadership is not allowing the issue to be debated by House members. Partisan politics should be put aside and the bill should be given a fair and expeditious hearing.

Paul Ryan, are you not Speaker of the entire House? A valid bill is a valid bill no matter which party its sponsors and co-sponsors belong to, and it deserves a hearing and an up-or-down vote.