So you may be thinking you’re doing a patients a huge favor when you write off their copays for your provider’s services, but in reality you could be hurting your practice or yourself badly from this process.
If your practice waives a patient’s financial responsibility of a copay, it could be violating the terms of the practice’s contract with the private payer. Private payers regard charging these copays as a part of the contract with the provider, waiving the payments without agreement from the payer could mean that you have breached the practice’s contract with the payer. This could permanently affect any current and/or future reimbursements from that payer. This could come to a costly civil lawsuit with the payer and have the potential of losing any contracts with that payer.
When you waive the copay or deductibles, you are not following the contract set with the payer, and it makes it difficult for any payer to want to enter a contract with you. In addition to this, payers use copays to be sure patients do not overuse services. Payers may see your practice waiving charges as an incentive to use more services, increasing the cost for the payer.
If the patient is enrolled in Medicare of Medicaid waiving a copay could cause anti-kickback status (AKS). The anti-kickback statute makes it illegal for any provider to knowingly and willingly accept bribes or other forms of compensation in return for generating Medicare, Medicaid, or other federal health care program business. Based on the Affordable Care Act, AKS violations are subjected to further penalties under the False Claims Act. These penalties can be between $5,500 and $11,00 per claim plus any repayment of improperly received funds.
From this, you could be found guilty of a felony from waiving their copay. This felony could leave you in prison for up to five years, a criminal penalty up to $25,000, administration penalty up to $50,000, triple damages, and permanent expulsion from the Medicare and Medicaid programs.
In essence it is important to not waive any patient copays unless further specified and documented in a patient’s file, not only for the practice’s sake, but for your own as well!