Paying Medical Doctors for Referrals



studin32-8The question has been asked by doctors nationally in many ways, “Can I pay the medical doctor in some sort of veiled monetary manner to get referrals?” The answer according to STARK, anti-kickback regulations, Medicare Office of Inspector General (OIG) and probably every other regulatory and disciplinary board, is a resounding, “NO!”

In fact, the OIG even has monetary guidelines of approximately $10 for a pen. That is the limit of what you can spend.  You are not even allowed to offer space in your facility unless it is under contract at “fair market value” and is an “arms-length” agreement. The days of an EMG company coming in and paying you $2000 for 2 hours, or backing into the pre-arranged price per test, is long over and has been deemed improper and, in many instances, very illegal.
With that being said, there is one commodity that can be compliantly used for getting referrals and that is your referrals. There is no law in the country that prevents doctors from cross-referring as long as each doctor has confidence in the other with no tangible strings attached. The solution is a simple cross-referral, when clinically indicated.
For too many years, medical specialists have been sucking the patients from the chiropractic profession on a one-way street. In many cases, they are getting your referral and, in turn, sending your patient to physical therapy after they are done, never to get adjusted again. As far as I am concerned, those days are LONG are over. I have spent 25 of my 30 years in chiropractic being made the fool by very nice “medical specialists” who have laughed all the way to the bank at my expense. For me, those days are no more and you need to put an end to this as well, immediately.
A few years ago, a friend shared with me that in relationships there are “hammers and nails.” The insurance companies, historically, are hammers because they have the money and you are the nail because you want that money. They can nail you whenever they choose because they have what you want. In the relationship with medical specialists, you are the hammer because you have what they want, the referrals. This gives you the control if you exercise it.
Your referral to a medical specialist often has a much larger price tag associated because chiropractic care has no surgeries, hospital inclusions, or multiple expensive tests. Our referrals usually involve the spine and associated pathology and the medical specialists need these referrals for their survival. In fact, neurosurgeons in New York pay over $300,000 for malpractice alone. They need your referrals to survive.
When you communicate with your current medical specialist who you have been referring to for years or will be referring to, it is time for a face-to-face meeting. I had these types of meetings many times and always did so with a successful conclusion because I realized that I was the hammer and they needed me much more than I needed them. Actually I had nothing to lose as I already had the patient with many choices of where to refer.
The conversation is short and the message quite simple, “I respect the incredible level of expertise that you give my referred patients. However, I have been referring many patients to you and my expectation is that you respect my level of expertise and honor a cross-referring relationship. I am not saying that you need to go 1-for-1 with me. However, as clinically indicated within your patient population, I expect to see some referrals from you on a consistent basis in order to maintain my relationship with you.”
This type of relationship historically is how the majority of practices have survived for generations and you are not breaking new ground or any laws. Remember, you are the hammer in this relationship and I always bordered on “veiled arrogance” in the conversation to let the medical specialist understand my resolve. I no longer chose to be taken advantage of and I no longer chose for chiropractic to be pushed around.
Be the hammer and do not let yourself be exploited by the medical specialists at the expense of your practice.


Dr. Mark Studin is the President of the Academy of Chiropractic and the Lawyers PI Program ( He is also the clinical director of the US Chiropractic Directory, the largest chiropractic entity on the Internet in the world. He can be reached at 631-786-4253.

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