Wiki Billing employees that are patients

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corikr77

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Our clinic wants to include medical services as a part of our benefit package for employees and their immediate family members. The intent is essentially to bill the employee's insurance company for services they received from our clinic, but any co-insurance/co-pay/deductible that the employee/patient would normally be responsible for would be written off as an employee courtesy. I have put many, many hours researching this and the information that I have found so far is that this should not be done for Medicare and private payers alike. (Anti-kickback laws, mis-representation of physician fees, fraud/abuse etc.) Our manager has checked with a lawyer and another clinic and they are saying that this intended policy is allowed, but I cannot find any actual documentation to support this. Does anyone have any documentation that they can provide either for or against this?

I look forward to your feedback! Thanks for your help!
 
My policy on this subject agrees with your position. It is not permitted and it is considered fraudent. We do NOT bill our employees AT ALL for services rendered. The financial impact is minimal for us, we have 20-25 employees. I suppose for a larger practice that policy would be harder to implement. The only time the employees incur costs for services is for labs drawn here and sent out to Labcorp, Quest or other facility. When this happens, because of the way we are set up with Labcorp the insurance still is not billed. Labcorp has an option to account bill (that means bill us), as if the patient did not have insurance at all. The employee is charged and pays the test at cost. What is this lawyer's position providers treating immediate family? The same? I hope not! I haven't done recent research to provide documentation, but you one source you should look to is the facility's insurance contracts. In ours, failing to collect any amount deemed the patient's responsibility is specifically addressed and not allowed. I have yet to see an exception outlined for employees.
 
I don't know what state you are in, or if it even matters, but we were previously advised by an attorney for the NC Medical Society that you should not bill an insurance company and write off the difference. This goes for employees and patients alike. I don't have anything in writing, but we were told that to do this would be considered insurance fraud.
I agree with the previous post that your insurance contracts should include documentation to address this. They will all state that you must bill patient for difference.
 
If you have contracts with the insurance companies you may want to consider the impact should they discover what you are doing. If you do not have a contract then you are by no means obligated to accept any restrictions from them. Hope that shines a light for you.
 
Not collecting copays, for employees (or anyone for that matter) is not only fraud, it is in violation of patient's insurance contract. Patients and providers may be dropped by carrier in this case.
 
Wish I could remember where I saw this...

but I believe it IS permissible so long as the cost of the copays, etc are subject to the same rules, tax laws, deductions, etc as other forms of compensation. Where these would be included, such as whether they are a taxed or non-taxed benefit, is something I would need to research. But I do recall seeing something that as long as it is subject to the same rules as the employee's wages and other benefits, it would be allowed. Would need to do further research....
 
Thank you for all of the replies so far. I appreciate the input. We are contracted, so that was another point that I was making with our manager, and the anti-kickback law. We will have to review the tax regulations too. So far I can't find anything that will allow this, only reasons against. So if you do remember where you saw that it was permissible, please let me know. Thanks again for all your input!
 
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