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Question: Do
Medicare and private insurance companies allow professional courtesy
discounts?
"Professional
Courtesy" refers to the provision of medical care to physician
colleagues or their families free of charge or at a reduced rate.
The
Health Insurance Portability & Accountability Act (HIPAA) of 1996
mentions that a physician is not allowed to give away services for free
or for below fair market value as inducement for patients to come to his
office.
The
federal anti-kickback statute (42 U.S.C. 1320-a-7b) addresses this issue
as well. This statute essentially prohibits physicians from
"routinely" providing services at a reduced rate or for no
charge as an inducement for those "patient's" to return to the
facility.
If
a physician routinely provides a discount or completely waives the fee
for his "friends/colleagues" etc.. s/he is in direct
violation. A violation of this provision of the anti-kickback statute is
punishable by a prison term of five years of less, a $25,000 fine, or
both.
The
AMA Report from the December 1997 meeting addressed this issue to their
Board of Trustees. The report states that their extensive research has
failed to uncover any instance where a physician has been prosecuted by
either the OIG or the DOJ for fraud or abuse based on the extension of
professional courtesy.
On
the other hand, prosecutions for the routine waiver of Medicare
coinsurance have involved schemes to provide medically unnecessary
services, and were not examples of professional courtesy.
The
AMA continues to press the DOJ and HHS that:
1.
Professional Courtesy should not be confused with routine waiver of
co-payment and other schemes to defraud payers.
2.
Professional Courtesy not be confused with intentional acts to generate
referrals for the provision of Medicare/Medicare covered services.
The
best advice is to consult your attorney. Additional information is
available on the following web sites:
Full
text of 42 U.S.C. 1320a-7b: http://www.law.cornell.edu/uscode/42/1320a-7b.html
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