Beware of Your Discount Policies
As a method to attract new patients, many offer huge discounts off their services. While this may be a routine occurrence in the department store, it may be a direct violation of Federal law, state law and/or your PPO policies.
In January 2012, Blue Cross Blue Shield of Illinois (BCBS) released a statement pertaining to discounts. In their Blue Review column, BCBS stated that
“Many businesses are offering discounted services through social media and other marketing channels as a way to attract new clients. This strategy does not apply to health care services you provide with BCBSIL members. The offering of any type of discount, such as a waiver of co-pay, is prohibited. Additionally, requesting pre-payment from your patient for covered services is not allowed.”
This may apply nationwide and should be reviewed in the applicable PPO policies.
In addition, Medicare has had a similar policy for nearly 10 years.
“A person who offers or transfers to a Medicare or Medicaid beneficiary any remuneration that the person knows or should know is likely to influence the beneficiary’s selection of a particular provider, practitioner, or supplier of Medicare or Medicaid payable items or services may be liable for civil money penalties (CMPs) of up to $10,000 for each wrongful act. The statute defines “remuneration” to include, without limitation, waivers of copayments and deductible amounts (or parts thereof) and transfers of items or services for free or for other than fair market value.”
When you sign a contract with a PPO organization, you must abide by all its rules and regulations. While these marketing ploys may succeed in attracting new patients, it may also succeed in attracting recoupment proceedings and the Office of Inspector General (OIG). Abide by the policies of the PPO and if in doubt, get clarification, in writing, from their customer service department.