Wiki Family Member Billing

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MWilliams01

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Are physicians prohibited from billing Medicare for all professional services provided to immediate family members. If so, I would appreciate the reference where this can be located.
 
I do not believe that physicians are specifically prohibited from treating family members. That having been said, however, the usual federal guidelines would definitely apply when billing Medicare: medical necessity and fraud/abuse guidelines. For example, it would not be wise to waive copayments or bill for a condition that was not medically necessary or that was non-covered (like a cosmetic procedure). I can see where it might be tempting to write off grandma's copay.

There's an ethical bend to this question, though, in terms of health boundaries. Too close for comfort, in my book, but not everyone has a problem with it, I guess.
 
In my mind....services provided to immediate family members were not covered by Medicare. This may have been my misinterpretation of something I read in the Stark Law.
 
Not allowed. Here is a paste from AMA

Ethical questions have been raised about physicians who treat members of their own families. Incomplete physical examinations, medical records, and immunizations are undesirable consequences of physicians' treating their own children. The 1901 code of ethics of the American Medical Association (AMA) noted that a family member's illness tends to obscure the physician's judgement and produce patient timidity. In 1989, fearing financial abuse by unscrupulous providers, Medicare barred payment to physicians who care for "immediate family members."

Who counts as a family member? Medicare's list of "immediate relatives" includes spouses, parents, children, siblings, stepparents, stepchildren, stepbrothers, stepsisters, children-in-law, siblings-in-law, grandparents, grandchildren, and spouses of grandparents or grandchildren. Since 1989, Medicare has not paid for patient care charges by immediately related physicians, their associates or their professional corporations. Blue Cross—Blue Shield, which has a stricter definition of "family member," has not paid for these charges since 1976.
 
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130 - Charges Imposed by Immediate Relatives of the Patient or Members of the Patient’s Household(Rev. 1, 10-01-03)
A3-3161, HO-260.12, B3-2332
A. General

These are expenses that constitute charges by immediate relatives of the beneficiary or by members of their household. The intent of this exclusion is to bar Medicare payment for items and services that would ordinarily be furnished gratuitously because of the relationship of the beneficiary to the person imposing the charge. This exclusion applies to items and services rendered by providers to immediate relatives of the owner(s) of the provider. It also applies to services rendered by physicians to their immediate relatives and items furnished by suppliers to immediate relatives of the owner(s) of the supplier.

http://www.cms.gov/manuals/Downloads/bp102c16.pdf

The guideline goes into further detail...
 
Just to add an FYI -- in every (non-Medicare) policy I have ever read, there is an exclusion for services where there is no expectation for the patient to pay the doctor in the absence of insurance.

In other words, unless you would bill your employees (or relatives and friends) your full fee, don't submit it to health insurance. And, if you only intend to collect what insurance pays and then waive the rest, it's fraud. :rolleyes:
 
We have a physician trying to bill services performed on himself, by himself. Same scenario I'm assuming?
 
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