jenngarcia
New
is it a breach of contract for physician to write off a patients deductible or coinsurance? Policy is BCBS PPO of Illinois
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Wiki writing off deductibles
- Thread starter jenngarcia
- Start date
SharonCollachi
Guest
File it under "Very Bad Idea" as a routine practice. You are enticing patients to use your services and in effect giving them a kickback.
As far as breach of contract, you would have to read your contract with BCBS.
As far as breach of contract, you would have to read your contract with BCBS.
Like Sharon said, definitely not as a routine practice. If the insurance company were to discover this, expect a world of problems. I would guess 99.9% of the time it is against your contract.
Most insurances will allow for financial hardship adjustments. You need an established policy and keep the patient's application and paperwork should it ever be needed.
Most insurances will allow for financial hardship adjustments. You need an established policy and keep the patient's application and paperwork should it ever be needed.
glanter
New
It's healthcare fraud.
csifuentes
New
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Q: IS IT EVER APPROPRIATE TO
WAIVE A PATIENT'S COPAYMENT
OR DEDUCTIBLE?
A: PROVIDERS should not reduce the cost of care to a patient by waiving or forgiving a copayment, cost-share or deductible. To do so is a violation of the Anti-Kickback Statute and is considered fraud and abuse, which can result in fines and other legal action.
The Anti-Kickback Statute provides criminal penalties for
individuals or entities that knowingly and willingly offer, pay, solicit, or receive remuneration in order to induce or reward the referral of
business reimbursable under Federal health care programs as defined in section 1128B(f) of the statute.
The offense is classified as a felony and is punishable by fines of up to $25,000 and imprisonment for up to five years. Violations may also result in program exclusions under section l 128(b )(7) of the
Act( 42U.S.C. l 320a-7(b )(7)), and liability under the False Claims Act (31 U.S.C.3729-33).
For more information on prompt payment discounts and the federal antikickback statute and Civil Monetary Penalties Law, see Office of Inspector General (OIG) Advisory Opinion No. 08-03 (http://oig.hhs.gov/fraud/docs/advisoryopinions/2008/AdvOpn08-03A.pdf).
Colleen Sifuentes
COO Consults
WAIVE A PATIENT'S COPAYMENT
OR DEDUCTIBLE?
A: PROVIDERS should not reduce the cost of care to a patient by waiving or forgiving a copayment, cost-share or deductible. To do so is a violation of the Anti-Kickback Statute and is considered fraud and abuse, which can result in fines and other legal action.
The Anti-Kickback Statute provides criminal penalties for
individuals or entities that knowingly and willingly offer, pay, solicit, or receive remuneration in order to induce or reward the referral of
business reimbursable under Federal health care programs as defined in section 1128B(f) of the statute.
The offense is classified as a felony and is punishable by fines of up to $25,000 and imprisonment for up to five years. Violations may also result in program exclusions under section l 128(b )(7) of the
Act( 42U.S.C. l 320a-7(b )(7)), and liability under the False Claims Act (31 U.S.C.3729-33).
For more information on prompt payment discounts and the federal antikickback statute and Civil Monetary Penalties Law, see Office of Inspector General (OIG) Advisory Opinion No. 08-03 (http://oig.hhs.gov/fraud/docs/advisoryopinions/2008/AdvOpn08-03A.pdf).
Colleen Sifuentes
COO Consults
notatthebeach@gmail.com
Contributor
My question is why would you do that? Especially deductibles. Your practice is losing money that way. As far as a contract goes, I doubt that it would be a breach of contract with the insurance company as long as you aren't charging the patient for more than the allowable. If you aren't charging them anything then you are just ripping yourself off.