HHS' inspector general's office reports to Congress that physicians who own or invest in clinical laboratories are far more likely than other doctors to refer Medicare patients for laboratory services.
Congress enacts section 1877 of the Social Security Act. The statute, which becomes known as Stark I, prohibits physician self-referrals for clinical laboratory services.
HCFA issues proposed rules that outline how Stark I will be enforced.
Section 13562 of the 1993 Balanced Budget Act is enacted. Stark II, as the statute comes to be known, expands the list of prohibited self-referrals to include 10 other designated health services, such as radiology and physical therapy services.
Stark II takes effect Jan. 1.
Stark I rules become final Aug. 14.
In September, the House Ways and Means Subcommittee on Health develops a set of amendments to the self-referral statute. The amendments are included in the Republican Balanced Budget Act of 1995, which eventually is vetoed by President Clinton.
Rules proposed by Stark II are published Jan. 9. They expand the definition of financial interest to include compensation arrangements.
Final Stark II rules are expected.