PUBLIC LAW 100-360—JULY 1, 1988
102 STAT. 723
"(i) has an ownership interest in the provider, or "(ii) receives compensation from the provider. "(B) EXCEPTIONS.—
"(i) Subparagraph (A)(i) shall not apply— "(I) if the ownership interest is the ownership of stock which is traded over a publicly-regulated exchange and was purchased on terms generally available to the public, or "(II) if the provider is a sole home intravenous drug therapy provider (as defined by the Secretary) in a rural area, "(ii) Subparagraph (A)(ii) shall not apply if the compensation is reasonably related to items or services actually provided by the physician and does not vary in proportion to the number of referrals made by the referring physician, but such exception shall not apply to compensation provided for direct patient care services. "(iii) Subparagraph (A) shall not be construed to apply to a referring physician whose only ownership or financial relationship with the provider is as an imcompensated officer or director of the provider. "(iv) Subparagraph (A) also shall not apply in such cases, established by the Secretary in regulations, in which the nature of the ownership or compensation does not pose a substantial risk of program abuse. "(C) SANCTIONS.— "(i) DENIAL OP PAYMENT.—No
pa3niient may be made under this part for home intravenous drug therapy services which are provided in violation of subparagraph (A). "(ii) CIVIL MONEY PENALTY FOR IMPROPER CLAIMS.—
Any person (including a home intravenous drug therapy provider or physician) that presents or causes to be presented a claim for an item or service that such person knows or should know is for an item or service for which payment may not be made under subparagraph (A) shall be subject to a civil money penalty of not more than $15,000 for each such item or service. The provisions of section 1128A (other than the first sentence of subsection (a) and other than subsection (Jb)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). "(D) REFERRING PHYSICIAN DEFINED.—In this paragraph, the term 'referring physician' means, with respect to providing home intravenous drug therapy services to an individual, a physician who— "(i) prescribed the covered home IV drug for which the services are to be provided, or "(ii) established the plan of care for such services.". (2) PROPAC STUDY.—The Prospective Payment Assessment 42 USC I395ww Commission shall conduct a study, and make recommendations ^°^^to Congress and the Secretary of Health and Human Services by not later than March 1, 1991, concerning appropriate adjustment to the payment amounts provided under section 1886(d) of the Social Security Act for inpatient hospital services to account
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