Little Health Law Blog
We previously wrote about concierge medical practices in 2022 but wanted to write an updated post because our clients have had renewed interest in starting concierge medical practices. Concierge medical practices are a subscription-based model where patients pay a membership fee to receive a menu of healthcare services. Concierge medical practices can provide healthcare services under several business models, including providing only non-medical services that are self-pay or providing both non-medical services that are self-pay and medical services that are billed to insurance and Medicare.
Before starting a concierge practice, it is important to be aware of the legal pitfalls that can come with starting a concierge medical practice. This blog covers two considerations that providers should consider before starting a concierge medical practice. If you need assistance setting up a concierge medical practice 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: It Is Important to State Clearly the Type of Services Your Practice Provides Under Its Membership Fee to Avoid Double-Billing.
A concierge medical practice’s membership contract is a crucial document for the practice. The membership contract outlines the services your concierge medical practice will provide, the membership fees that the patient will pay, and what services are covered under the membership fee. If your concierge medical practice provides both non-medical services that are self-pay and medical services that are being billed to insurance and Medicare, outlining the services you provide under your membership fee is critical because otherwise, the membership fee may cover services that are covered under Medicare, and the practice would incur double billing, which is prohibited under Medicare. Double-billing Medicare patients can subject a practice to civil monetary penalties ranging from $10,000 to $50,000 for each violation.
Second Consideration: Practices Should Be Cautious About Advertising Perks Such As “Immediate Access” or “Unlimited Visits.
Although offering certain features such as “immediate access” to physicians or “unlimited visits” as part of the membership fee sounds attractive to patients, these features can also create legal risk for your concierge medical practice. “Immediate access” may not be available at any given moment, and nothing is ever “unlimited.” If the concierge medical practice does not follow through on these features, it could expose concierge medical practices to legal claims such as false advertising or breach of contract.
If you need assistance setting up a concierge medical practice 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.