# specific laws prohibiting the write off of co-insurance and deductible?



## chall (Aug 8, 2011)

Does anyone know what states have specific laws prohibiting the write off of co-insurance and deductibles? Or where I can find this information?

Thank you,
Carol Hall
chall@xifin.com


----------



## mitchellde (Aug 8, 2011)

HIPAA has a section that spells out that by knowing you are required to collect a copay or deductible and you failure to make reasonable attemt to do so can constitute fraud.  The Copay and deductible are the patient's obligation as a part of their contract with the payer.  You also have a contract that says you are required to collect the copay and deductible.  If the patient claims they cannot pay then the payer can make the decision that they do not pay not the provider.There are numerous other statutes and laws that forbid this practice. Just go to the internet and start looking.  You can google physician professional courtesy and find a ton of information.


----------



## btadlock1 (Aug 8, 2011)

chall said:


> Does anyone know what states have specific laws prohibiting the write off of co-insurance and deductibles? Or where I can find this information?
> 
> Thank you,
> Carol Hall
> chall@xifin.com



See: Anti-Kickback Statute
http://www.physiciansnews.com/law/1003.html

"Generally, the civil money penalties law prohibits a physician from offering or transferring remuneration to any individual eligible for Medicare or Medicaid that such physician knows or should know is likely to influence the individual to order or receive from such physician any item or service for which payment may be made under Medicare or Medicaid. Violation of the Civil Money Penalties law can result in fines of up to $10,000 for each wrongful act.

Remuneration includes the waiver of coinsurance and deductible amounts and transfers of items or services for free or for other than fair market value. Remuneration does not, however, include:

• The waiver of coinsurance and deductible amounts by a physician, if the waiver is not offered as part of any advertisement or solicitation; the physician does not routinely waive coinsurance or deductible amounts; and the physician waives coinsurance and deductible amounts after determining in good faith that the individual is in financial need or failure by the physician to collect coinsurance or deductible amounts after making reasonable collection efforts."

The jist of the AKS/Safe Harbor rules on this issue, is that you can waive coinsurance/deductible in some situations, (when the patient is financially disadvantaged), but routinely waiving them is prohibited. The rationale is, patients use healthcare services more often if it doesn't cost them anything, which costs the government more money. 
A. They don't want to pay more, in general, so the deductible is sort of a deterrent. 
B. If your doctor becomes known for not charging deduct/coinsurance, it would be an incentive for patients to see him, as opposed to other providers that might make them pay. 

As Debra said, waiving these fees without any good reason could violate several state and federal laws - AKS is only one. Additionally, it's probably explicitly prohibited in your contract, so check there as well.


----------

