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Thread: waiver of payment

  1. #1

    Question waiver of payment

    AAPC: Back to School
    I need help please.

    We a few physicians with in a group practice who continue to not collect copays from other physicians and physician family members outside of our practice. Our physician will tell our billers to write off as professional courtesy.

    We also have physicians who will treat employees within the practice, let the claim go to the insurance, and then tell our billers to write off the deductible, coinsurance, or copay as professional courtesy.

    Doesn't this fall under the anti kickback and stark laws, can this qualify as fraud as a waiver in payment, or am I way off the beaten path?

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    HIPPA has several definitions of health care fraud. A medical attorney wrote a very good article a few years back on this subject. He stated by knowing your are to collect a copay or deductible and failing to make the attempt to do so constitues an act of fraud. The patient has a contractual obligation to pay their copay and deductible in full and you cannot relieve them of this responsibility. The AMA opinion statement 6.12 states that the AMA will not sanction this practice of professional courtesy discounts and write offs as it violates numerous state and federal regs and statutes. OIG compliance regulation 103 states that physician ae not allowed to discount or provide at no charge services for friends, family, collegues, or coworkers.
    In other words you are correct.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007
    North Carolina


    Professional Courtesy is addressed by the OIG...

    Page 14/Section C


  4. #4
    Join Date
    Apr 2007
    Traverse City, MI


    This is exactly the OIG document that I needed on this issue! Thanks so much Rebecca!!

    Gina, CPC

  5. #5
    Join Date
    Apr 2007
    North Carolina


    Glad I could help~

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