How Does a Doctor Waive Copays Without Being Charged with Fraud?
Full Question:
Answer:
The most common ways physicians reduce the cost of care for patients are waiving the co-pay ("insurance only") and giving the patient a discount on the care. In most situations, both private insurers and the federal government ban waiving the co-pay. Medicare has some provisions allowing the co-pay to be waived for documented indigency.
Both private insurers and Medicare require the physician to make reasonable efforts to collect co-pays that are billed to the patient. In waiving the patient’s copay, the physician may compensate for the loss of reimbursement by charging the insurance company a rate higher than normal or over-billing to receive a greater than normal reimbursement.
Fraud requires proving intent to deceive. A release and waiver of liability may be used to protect a business from the foreseeable damages that may occur in the scope of being employed to perform a service. However, it is generally not enforceable against intentional wrongdoing, such as fraud. A release form will generally be upheld as long as the contract for services is entered into freely and the damage isn't caused by an intentional, willful, or reckless act.
For further discussion, please see:
http://www.gentlebirth.org/archives/waivingCopayment.html
http://www.cms.hhs.gov/center/provider.asp
http://www.cms.hhs.gov/MedHCPCSGenInfo/
http://www.cms.hhs.gov/MedHCPCSGenInfo/20_HCPCS_Coding_Questions.asp#TopOfPage
