Often, there are cases in which finances may prevent a patient from receiving proper medical attention. While physicians may be tempted to provide the required funds or waive the patient’s cost-sharing obligations, they may be putting their practice at risk.
Specific goods or services may not be provided by a physician when they would otherwise be unattainable. Providing these funds could be considered an exercise of undue influence. The physician is essentially paying the patient to return to the practice for future treatment.
Both the federal civil monetary penalties law and the federal anti-kickback law forbid healthcare providers from providing funds and thereby encouraging a referral of business. Physicians who choose to waive fees or provide funds can be held liable under these laws. The U.S. Department of Health and Human Services views violations of these Medicaid and Medicare requirements as fraud.
Physicians should consider the consequences when choosing to provide financial assistance. Before making a decision, physicians should consult with an attorney to develop a charity care policy. Guidelines need to be established for the practice in order to avoid future legal issues.
Adhering to a strict set of guidelines for charity care is the safest decision for the practice, as these guidelines may be what save the practice from liability.
Author: Lauren Daniels