PROFESSIONAL COURTESY: When Is Pro Bono Care Fraud?
Is physicians' "cherished tradition" of "professional courtesy" - - the practice of treating other physicians or their families for free or waiving their insurance co-payments -- a crime under the government's strengthened anti-kickback laws? When Congress passed health insurance portability legislation three years ago, many physicians saw new measures contained in the legislation as an attack on the "honorable practice" of providing pro bono care for other physicians. In November, the Department of Health and Human Services seemed to confirm their suspicions by warning that professional courtesy "could run afoul of appropriate health care billing practices." To counter the perceived attack, the American Medical Association passed a resolution in December to petition the government "to reverse the unreasonable and intrusive policy of considering professional courtesy among physicians fraud," the Wall Street Journal reports. The organization is also requesting a clear explanation of which types of professional courtesy are considered legal and which are not.
Hospital Reactions; Government Advice
Some groups, however, are afraid to wait for the results of the AMA's petition and have begun passing guidelines regarding professional courtesy. Chilton Memorial Hospital in Pompton Plains, NJ, is implementing a policy making it clear to physicians who come to the hospital for treatment that they will be expected to pay for services rendered, "like every other patient." The federal government's advice? The best way for physicians to avoid potential legal pitfalls "is simply to waive the entire bill, not just the co-payment," so that there is no chance Medicare will be overbilled. In addition, the government cautions that "doctors should avoid the appearance of soliciting kickbacks by making sure not to favor colleagues who are in a position to give patient referrals" (Jeffrey, 2/16).