True or False? Discounting Your Fees Is Illegal


A simple true or false would be nice. Unfortunately, it depends on who you ask, what state you are in, if the patient is federally insured, AND their particular circumstances. So much for straight answers to a simple question!

When consultants do answer questions about discounting , it is usually followed by “consult with your health care attorney before offering any type of discounts”. This would be great advice , except most of us do not have a health care attorney.  Others will tell you discounting is perfectly legal, as long as it is done consistently and in accordance with your written compliance program. More  great advice, but the reality is many of us still haven’t put a full compliance plan in place.

So who cares if the answer is True or False?

What’s all the fuss about discounting anyway? Can’t you charge what you want to whomever you want? Can’t you just down code your adjustments, exams or X-rays  to save a patient some money? What’s the big deal in charging more for PI, Workers Comp and insurance patients than you do for cash? All you are doing is trying to help a patient right? It’s no big deal…right?


discountingfeesIn the days before insurance, third party reimbursement, state and federal payers, things were simpler. When someone else is paying part or all of the costs for health care, especially the government, rules change and regulations apply. This is when discounting the wrong way can cost you.  It’s called doing the right thing the wrong way.

You may be trying to help an uninsured or underinsured patient by offering discounts, but many doctors end up putting themselves at risk in the process.

Dual fees schedules, (charging more to insurance companies than you do to your cash patients), improper time of service discounts, (reductions that are really MORE than a reasonable bookkeeping reduction), are illegal in most states . Offering discounts that do not fall into one of Medicare’s safe harbors can cause an inducement and is absolutely a violation of federal regulations in EVERY state, subject to a $10,000 fine PER OCCURRENCE!

Violation of state and federal regulations against inducements or triggering anti-kickback statutes can lead to serious fines and career ending penalties as well.

So what is the right answer to the True or False question?

Discounting your fees CAN be illegal, if you do it the wrong way! Keep reading and find out how to offer discounts the RIGHT way, in every state and for any patient group.

Follow the rules.

1. Document correctly. The rules in this area are quite clear and there are many resources and guidelines to follow.

2. Code correctly. Again, follow the rules. Do not up code for more reimbursement when insurance is available and do not down code to reflect lower charges as a means to offer discounts. It is just as improper and illegal as up coding.

3. Discount correctly. That is a new one for most doctors.

Here is how you offer discounts the RIGHT way. Hire a health care attorney if you’d like, put your compliance plan in place…AND, if you don’t do anything else, consider joining, and encourage your patients to join a Discount Medical Plan Organization (DMPO). DMPO’s are regulated by the Department of Insurance in most states and have been around for years.

Why a DMPO? Simple. These plans use the contract model similar to what you use now, which  allow you to contract with multiple insurance companies for different rates on the same codes  without it being a “dual fee schedule”. Using a DMPO, you can still bill your UCR fees and have the protection of a “contract” that allows you to offer network-based discounts to your cash and underinsured patients. Most all patients are familiar with “buying clubs” such as Sam’s Club  and they are familiar with networks. Experience shows they do not hesitate to join these network plans to save money!

Using a DMPO really is one of the most logical, legal, and ethical ways to allow you to accept a lower fee than your normal UCR clinic fees. It helps you help your patient, and it does not put you at risk!  A good cash discount plan solves so many of the potential problems for you and really helps the patient…the RIGHT way!


Article submitted by ChiroHealthUSA.

Dr. Ray Foxworth is a certified Medical Compliance Specialist and is President of ChiroHealthUSA.

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