The Patient Protection and Affordable Care Act addresses the issue of self-referral. Specifically, physicians referring their patients for magnetic resonance imaging, computed tomography, or positron emission tomography on the "in-office ancillary services" exception to the Stark/physician self-referral law are now required to provide a written notice to their patients.

This provision also applies to any other "designated health services" that the Secretary of Health and Human Services deems appropriate. That means services that dermatologists refer for, such as pathology, might at some point be affected by this provision. At the time of referral, the patient must be informed that he or she may obtain the services elsewhere, and be provided a written list of alternative suppliers in the area.

As of Sept. 23, 2010, the Secretary has developed a protocol that allows providers and suppliers to self-disclose an actual or potential violation of the physician self-referral/Stark law. Providers who self-disclose may receive a reduced violation from the Secretary. However, the decision to self-disclose a potential violation should be made in consultation with an attorney who specializes in health care law.