In the presence of profession-negating practices like POPTS, even leaders of the professional community such as Susan Chalcraft, PT, MS (who works for an institution which includes in its mission statement the provision of pro bono physical therapy services for underserved populations) or Peter McMenamin, PT, MS, OCS (who has invested considerable time and money into specialty training and board certification) are limited in their efforts.
According to Justin Elliott, Associate Director of the APTA State Government Affairs, fear of stronger regulation had a "chilling effect" on the growth of POPTS for about five years, but, in the 1990s, Stark "lost its punch," with declining reimbursement motivating physicians to seek "creative business models" (70) in the exceptions to Stark II.
As of this writing, POPTS are banned in Delaware, South Carolina, and Missouri, but they are legal in Tennessee, Alabama, and Rhode Island; cases are pending in Washington and Illinois.
In 2002, the Delaware Attorney General declared that POPTS constitute illegal fee splitting and kickbacks, issuing an opinion that the Delaware Physical Therapy Act prohibits physical therapists from having financial relationships with referring physicians.
In 2006, the South Carolina Supreme Court declared that POPTS constitute illegal fee splitting and kickbacks, ruling that it was the legislative intent of the PT Act to "prohibit a physical therapist from working as an employee of a physician when the physician refers patients to the physical therapist for services," recognizing such prohibited referrals for pay as "kickbacks.