General Category > General Questions
Anit-Kickback and Stark Law Question
PMRNC:
I'm going to disagree with this attorney and explain why. A fee for service is if I charged $5 per claim. (example)
FEE splitting is any method in which you are sharing the profits of the revenue with the provider (IE %). If I am billing for example 6% of total practice revenue, the doctor is indeed "FEE splitting" (receiving a portion of receivables)
Now I don't know how the scenario was presented to the attorney which could make a BIG difference in his response.
Read this again:
--- Quote --- What you or medical billers are actually getting is a "fee for service". The "anti-kickback' or Stark violations only occur when the Dr. is actually splitting patient fees
--- End quote ---
I also want to add another discrepancy.. the anti-kickback statute does NOT differentiate between insurance/patient payments. As that statement is written above, it says "patient" fees. The source of the revenue that is to be split, shared, etc includes all means of revenue..insurance.. and patient. just wanted to point that out.
I live by something that makes sense to me and it's something my attorney is also a firm believer.. IF IN DOUBT don't do it..and "BETTER SAFE THAN SORRY"
DMK:
While I agree with the legal principle, to a point, does anyone else find it sad that you can't express your gratitude to your customers without some sourpuss trying to fine you!
As a provider, we like to thank patients for referrals. You used to be able to give them a t-shirt. No more. Even a card thanking them can be a HIPAA (I can never remember if it's 2 P's or 2 A's) violation.
We can't even give them a free adjustment on their birthday. >:( What's the world coming to when you can't be nice, or kind, or even just charitable to someone who's having a hard time?
midwifebiller:
So...the holidays are coming up and we would really like to so something for our wonderful providers--and still stay legal.
What do you all do for your clients around the Christmas/Channukah/Winter Solstice/New Years season?
jcbilling:
Thanks for posting that Alice! I was really disappointed with your recent newsletter where you all very strongly came out against a billing company helping a provider market their practice. After asking many major healthcare consultants in the industry and reading the law myself, I have to agree that it is not illegal for us to help our clients in this manner.
I realize there are those that disagree - but I think it's a valuable and legit service that our clients could benefit from.
JMO...Charity
PMRNC:
--- Quote ---I was really disappointed with your recent newsletter where you all very strongly came out against a billing company helping a provider market their practice. After asking many major healthcare consultants in the industry and reading the law myself, I have to agree that it is not illegal for us to help our clients in this manner.
I realize there are those that disagree - but I think it's a valuable and legit service that our clients could benefit from.
--- End quote ---
You realize there are those that "disagree"? I'm very confused.. there are many LAWS in life I disagree with..but the Stark and Anti-kickback statutes are NOT really as grey as you think..they are pretty clear cut..I dont' find them confusing.. just because we don't like it doesn't mean it isn't clear and it's something to agree/disagree with. Either you break the laws or you stay on the straight and narrow, I would think it more reasonable and fair to tell your client you want to spare them the legal consequences rather than just do it to make them happy! ??? ??? ???
I have KNOWN billing companies to say "Oh I don't agree with the fee splitting laws" and turn around and do it anyway not even realizing it's not their neck on the line..it's the doctors! You are just hit in the pocket book if you are in a state that prohibits percentage based billing/fee splitting because your contract is NULL/VOID. The doctor can be sanctioned and disciplined.. I've SEEN it happen and their are case's on file with that.
"To violate the anti-kickback law, one must knowingly and willfully offer or pay, solicit or receive remuneration in exchange for referring a patient for an item or service payable by the government, or for ordering or arranging for ordering any such item or service. " If you send a FLYER to a non-patient, coupon, non-coupon advertising and that patient comes into the practice.. YOU HAVE KNOWINGLY AND WILLFULLY OFFERED TO SOLICIT IN ORDER TO RECEIVE Remuneration.. YOU got paid..the patient got solicited, and came into the practice. I SEE NOTHING CONFUSING THERE. In fact it's as PLAIN blue as the sky above.
There are MANY cases on file where PM companies have been involved in lawsuits for helping and aiding in physicians marketing services.. There are quite a few precedent cases on the books, just type in: PPM Company violates Anti-Kickback into Google. I did and found 7 cases on the first page alone. There are also OIG advisory opinions on PM companies offering marketing/referral services.
--- Quote ---We can't even give them a free adjustment on their birthday. Angry What's the world coming to when you can't be nice, or kind, or even just charitable to someone who's having a hard time?
--- End quote ---
As for providing your client with a gift during holiday's ..totally separate thing and very easily solved, YOU can buy your provider a gift certificate for dinner, a gift basket, flowers, etc don't confuse client with patient.
As a billing company myself, I am ALWAYS finding my clients wanting to know "WHY" they can't do certain things. I explain it once, if it puts liability on me and they do it anyway despite my recommendation, they breach MY contract. It's even more frustrating being in the industry where you are educating OTHER billers and they still want to argue or debate the law.. They don't impose any liability on me, I just end up with a bump on my head from knocking my head against my desk. If you don't' agree with law and want to violate it.. be my guest. It is ok to NOT like it.. or advocate to change it. But to disregard it ..then you get what you deserve. Sorry that seems a bit harsh but it's true.
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