Generally, federal law prohibits physicians (and immediate family members) who have a financial relationship with a provider of Designated Health Services from making a referral of a Medicare or Medicaid patient to that provider.  Likewise, the provider is prohibited from filing claims to Medicare or Medicaid under those circumstances. There are exceptions. Among the exceptions is “in-office ancillary services.” [See § 1877 of the Social Security Act]. The exception is subject to numerous conditions, and Congress added another condition as part of the Patient Protection and Affordable Care Act. For certain in-office ancillary imaging services (i.e., MRI, CT, PET, and other imaging services to be determined by the Secretary of DHHS) furnished on or after January 1, 2010, the referring physician must now inform the patient, in writing, at the time of referral that they may obtain the services from a person other than 1) the referring physician, 2) a physician who is a member of the same group practice as the referring physician, or 3) individuals who are directly supervised by the physician or by another physician in the group practice. [See § 1877(b)(2)(A)(i) of the Social Security Act.] The patient must also be provided, in writing, a list of “suppliers” who furnish the service in the area where the patient resides. [See PPACA § 6003(a), (b).]