Full question:
Recently found out that the waiving of co payment and deductible for State benefit plan, (not Medicare or Medicade),S. coporation, one employee for out patient mental health., out of net work no contracts signed is: considered to be Fraud and potential violation of the medicare and medicaid Anti-Kick back law. I had no idea. The insurance co,m that just recently was contracted by the State of NJ to opprovide services to teachers, police both on the state, county and local level.,Has just sent letters out to all non partiscipating providers saying they will begin to file law suit. Most patient are poor, they were not informed of the resent change in their mental health package. Considerably lowered their mental health fees, leaving them to pick up the high out of pocket fees. I have seen these patient for a very long time, all on Medication., I have not waived the co pys it just that they don't pay or give me little cah up front. for the co pay. Is there a form or a waiver they can sigh to protect me from Fraud
- Category: Medicaid
- Date:
- State: New Jersey
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
This content is for informational purposes only and is not legal advice. Legal statutes mentioned reflect the law at the time the content was written and may no longer be current. Always verify the latest version of the law before relying on it.
