# Providers treating their own family members



## 01100548 (Jun 18, 2009)

I have a physician who wants to see his own family members.  Can anyone give me advice or tell me where to find information on this?  Is is legal?

Thanks,

Wendy


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## kbarron (Jun 18, 2009)

I don't believe you can do that. I do not have a link, perhaps someone else does.


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## LLovett (Jun 18, 2009)

I know you aren't allowed to bill Medicare for those services. I can't find the link right off though. They feel that this is something that would normally be provided free of charge since they are family so they shouldn't have to pay for it.

I don't know if it is illegal, but where I used to work there was a company policy against it. The thought being their judgement would be compromised due to personal/emotional envolvement.

Laura, CPC


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## 01100548 (Jun 18, 2009)

Here is the situation....  We are a pediatric office.  He wants to give his child immunizations that are not covered by the insurance so he can adjust the balance. 
Thank you for replying!


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## RebeccaWoodward* (Jun 18, 2009)

*E-8.19 Self-Treatment or Treatment of Immediate Family Members*

Physicians generally should not treat themselves or members of their immediate families. Professional objectivity may be compromised when an immediate family member or the physician is the patient; the physician’s personal feelings may unduly influence his or her professional medical judgment, thereby interfering with the care being delivered. Physicians may fail to probe sensitive areas when taking the medical history or may fail to perform intimate parts of the physical examination. Similarly, patients may feel uncomfortable disclosing sensitive information or undergoing an intimate examination when the physician is an immediate family member. This discomfort is particularly the case when the patient is a minor child, and sensitive or intimate care should especially be avoided for such patients. When treating themselves or immediate family members, physicians may be inclined to treat problems that are beyond their expertise or training. If tensions develop in a physician’s professional relationship with a family member, perhaps as a result of a negative medical outcome, such difficulties may be carried over into the family member’s personal relationship with the physician.
Concerns regarding patient autonomy and informed consent are also relevant when physicians attempt to treat members of their immediate family. Family members may be reluctant to state their preference for another physician or decline a recommendation for fear of offending the physician. In particular, minor children will generally not feel free to refuse care from their parents. Likewise, physicians may feel obligated to provide care to immediate family members even if they feel uncomfortable providing care.
It would not always be inappropriate to undertake self-treatment or treatment of immediate family members. In emergency settings or isolated settings where there is no other qualified physician available, physicians should not hesitate to treat themselves or family members until another physician becomes available. In addition, while physicians should not serve as a primary or regular care provider for immediate family members, there are situations in which routine care is acceptable for short-term, minor problems.Except in emergencies, it is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members. (I, II, IV) Issued June 1993.

http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf

Page 594


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## wverret (Jun 18, 2009)

*Treating your own family members*

i would check with your state's physican licensing board.  I do believe it is illegal to do this.


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## KimberlyLanier (Jun 18, 2009)

Services to Relatives - coverage Exlusion 
Medicare regulations do not provide payment under Part A or Part B of Medicare for expenses that constitute charges by immediate relatives of the beneficiary or by members of his/her household. The intent of this exclusion is to bar Medicare payment for items and services furnished by physicians or suppliers who 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 a related physician or supplier, even if the bill or claim is submitted by an unrelated individual or by a partnership or professional corporation. It applies to items and services furnished incident to a physician's professional services (e.g., by the physician's nurse or technician) only if the physician who ordered or supervised the services has an excluded relationship to the beneficiary.

Immediate Relative
The following degrees of relationship are included within the definition of immediate relative:

husband and wife 
natural or adoptive parent, child and sibling 
stepparent, stepchild, stepbrother and stepsister 
father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law and sister-in-law 
grandparent and grandchild 
spouse of grandparent or grandchild 
A brother-in-law or sister-in-law relationship does not exist between a physician (or supplier) and his/her spouse's brother-in-law or sister-in law.

A father-in-law or mother-in-law relationship does not exist between a physician and his/her spouse's stepfather or stepmother.

A step-relationship and an in-law relationship continue to exist even if the marriage upon which the relationship is based terminates through divorce or through the death of one of the parties.

For example, if a physician treats his stepfather after the death of his natural mother the service is considered furnished to an immediate relative and is excluded from coverage. Another example is if a physician treats his stepfather after the stepfather and natural mother are divorced, the service is considered furnished to an immediate relative and is excluded from coverage. Finally, if a physician treats his father-in-law after the death of his wife, the service is considered furnished to an immediate relative and is excluded from coverage.

Members of Patient's Household
Also excluded are people sharing a common abode with the patient as a part of a single family unit, including those related by blood, marriage, or adoption, domestic employees and others who live together as part of a single family unit. A mere roomer or boarder is not included.

Charges for Physician and Physician-Related Services
This exclusion applies if the physician has an excluded relationship to the beneficiary. It includes services that are furnished, ordered, supervised or services that are incident to his/her services (e.g., by the physician's nurse or technician). It also includes services of a physician who belongs to a professional corporation.

The term "professional corporation" means a corporation that is completely owned by one or more physicians or is owned by other health care professionals as authorized by State law. It is operated for the purpose of conducting the practice of medicine, osteopathy, dentistry, podiatry, optometry or chiropractic. Any physician or group of physicians that is incorporated constitutes a professional corporation. (Generally, physicians who are incorporated identify themselves by adding letters such as P.C. or P.A. after their title.)

Charges for Items Furnished by Non-Physician Suppliers
This exclusion applies to charges imposed by a non-physician supplier that is not incorporated, whether the supplier is owned by a sole proprietor who is related to the patient or by a partnership in which even one of the partners is related to the patient. The exclusion does not apply to charges imposed by a corporation (other than a professional corporation), regardless of the patient's relationship to any of the stockholders, officers or directors of the corporation or to the person who furnished the service.


Kimberly CPC


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## RebeccaWoodward* (Jun 18, 2009)

http://www.ama-assn.org/ama/pub/abo...medicine/state-medical-society-websites.shtml

Select your state.  Once you arrive to TN's Medical Assoc...enter "treating family members" in the search engine.

Your information should be in link 21.  _However_, it requires a member to view. Maybe you can network with someone who has those privileges.


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## 01100548 (Jun 18, 2009)

Rebecca---  Your link was exactly what I needed, but your right.  I have to have a log in.  I am in Tennessee if anyone would like to copy that article and email it to me at multiplesmom2000@yahoo.com.

I will be sure to pass everyone's response on to the provider!  Thank you!


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## ARCPC9491 (Jun 18, 2009)

*Not just Medicare*

Pull your commercial/private contracts too. There is verbage in them similiar to Medicare's policy, as stated above.


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## mitchellde (Jun 18, 2009)

Also OIG Compliance Reg 103 states Physicians may not no charge or provide at a discount services for friends, family, colleages, or coworkers.


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## donsqueen (Jun 19, 2009)

You are also going to want to look at documents regarding courtesy discounts. This practice is no longer allowed. In this case, a "patient off the street" who did not have insurance coverage for the immunization would need to pay for the immunization, therefore, while it is probably ok for the physician to give his child's immunization himself, he would need to pay according to the same policy for a "patient off the street". 

If your clinic has a written policy for discounts for employees or members of their family, that policy would need to be followed. 

When I worked for a private clinic, we did not allow our providers to treat family members or themselves. (They still did though). We had a written policy for discounts for employees and family members. When they did break the policy (the owner was the worst), because of contract language, we were unable to bill the insurance.


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