Practice Management Alert

Question: Should our practice waive charges for our employees who are seen by our physicians? New Mexico Subscriber Answer: Some practices argue that waiving charges, or simply not charging employees for any services, is acceptable. From a compliance standpoint, waiving charges for your own office staff is risky. The Office of Inspector General's (OIG) compliance program guidelines for individual and small group physician practices, published in the Federal Register on Oct. 5, 2000, specifically discussed "professional courtesy" arrangements. These arrangements include waiving all or part of fees for services provided to the physician's office staff, and "insurance-only billing," which is waiving coinsurance obligations or other out-of-pocket expenses for employees. According to the OIG guidelines, whether such arrangements violate fraud and abuse laws depends on two factors:

1. how the recipients of the professional courtesy are selected

2. how the professional courtesy is extended. If the recipients of the professional courtesy are selected "in a manner that directly or indirectly takes into account their ability to affect past or future referrals, the antikickback statute which prohibits giving anything of value to generate federal healthcare program business may be implicated," the guidelines say. A claim submitted as a result of such a professional courtesy may also implicate the False Claims Act, according to the OIG.

The guidelines offer this advice: "The legality of the particular professional courtesy arrangements will turn on the specific facts presented, and, with respect to the antikick-back statute, on the specific intent of the parties. A physician's practice may wish to consult with an attorney if it is uncertain about its professional courtesy arrangements."