Dermatology Coding Alert

Question: We were reading the January 2007 issue of Medical Office Billing & Collection Alert and it mentioned the issue of waiving copays and deductible. The article mentions how this is, of course, illegal and also violates a provider's contract with insurance carriers. We would like to know how this applies to non-contracted carriers.

We've heard that some laboratories are waiving copays and deductibles when dealing with carriers they are not contracted with. In our eyes, this still violates OIG and False Claims Act guidelines regardless of whether it is a governmental or commercial payer, contracted or not contracted. Would you please clarify this issue for us?


North Carolina Subscriber

Answer: You're right to be cautious when it comes to waiving copays and deductibles. You shouldn't follow the example of the laboratories you've mentioned. The practice of waiving copays does in fact violate the Office of the Inspector General (OIG) regulations and False Claims Act.

Anytime you waive a copay or deductible, what you then submit on the insurance claim is not what you're actually submitting as payment, which is an automatic violation of OIG and the False Claims Act.