Little Health Law Blog
Our healthcare law firm works with many providers and healthcare practices to assist them in complying with federal, state, and local laws. Our clients often ask if they can provide discounts to patients who are in financial need, especially if the patients are on Medicare. Providing discounts to patients can carry substantial legal risks, so it is important to be compliant before providing such discounts. This blog covers two considerations that providers and practices should consider before offering discounts to patients who are on Medicare. If you need assistance setting up a compliant arrangement to offer discounts to patients or would like to discuss this blog post, you may contact our healthcare law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.
First Consideration: Federal Fraud and Abuse Laws Can Prohibit Providers from Offering Discounts to Medicare Patients
Although providers may want to provide discounts to patients who are in financial need so patients can get the care they need, federal fraud and abuse laws prohibit certain kinds of discounts that may be seen as a way to induce patient referrals or steering patients to a particular provider. The Anti-Kickback Statute (“AKS”) prohibits providers from giving anything of value, including free or otherwise discounted services or a routine waiver of coinsurance/deductibles, to induce (or in return for) the purchase or order of any good or service that may be reimbursed by a Federal or state health care program (e.g., Medicare, Medicaid, TRICARE, etc.). The federal Civil Monetary Penalty Statute imposes fines against healthcare providers who gives or offers anything of value to a Medicare or other state health care program beneficiary (e.g., Medicaid) beneficiary that is reasonably likely to influence the beneficiary’s selection of a particular provider for the order or receipt of any item or service for which payment may be made by Medicare or a state healthcare program. Violating federal fraud and abuse laws can lead to severe penalties, including criminal penalties, civil penalties, or exclusion from Medicare.
Second Consideration: Federal Fraud and Abuse Laws Allow Certain Discount Arrangements That Must Meet Specific Requirements
Recognizing the need for certain discounts to exist, federal fraud and abuse laws permit certain discount arrangements, but these arrangements must follow strict requirements to be compliant. AKS contains several safe harbors that allow providers to offer certain discount arrangement, and the arrangement must satisfy every element of the safe harbor to be permissible. Safe harbor elements are very fact-intensive and require the expertise of an experienced healthcare attorney to ensure your arrangement falls within an AKS safe harbor.
The federal Civil Monetary Penalty Statute also allows for the waiver of copayment, coinsurance, and deductible amounts based on financial need if certain requirements are met, including that the provider determines in good faith that the patient is in financial need and waives the coinsurance and deductible amounts as a result, or the provider fails to collect coinsurance or deductible amounts after making reasonable collection efforts. AKS also has a safe harbor for waiving beneficiary copayment, coinsurance, or deductible amounts that also has fact-specific elements to satisfy to ensure the waiver of copayment, coinsurance, and deductible amounts does not violate AKS.
If you need assistance setting up a compliant arrangement to offer discounts to patients or would like to discuss this blog post, you may contact our healthcare law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.