PROFESSIONAL COURTESY

Professional Courtesy, is this tradition eventually will disappear?



Professional Courtesy, is this tradition eventually will disappear?

Introduction

The term professional courtesy can refer to a wide variety of practices, but most commonly, it means the provision of discounted or free health assistance to medical professionals (physician assistants, doctors, dentists and nurses) and their families. Particularly, the term has also become associated with the practice of waiving co-insurance or other out of pocket expenses for certain patients. Professional Courtesy is a tradition that dates back to the time of Hippocrates, and over the years, this tradition has been thoroughly inbuilt in many physicians' practices.

Description and Analysis

There are a number of reasons why a health care professional might choose to provide health care services for free or at a reduced rate. In some cases, the provision of professional courtesy is meant as a reflection of the close professional and personal relationships that have been built among health care professionals. Some professionals believe that this time, tested practice serves to build professional bonds between nurses, physicians, dentists, physician assistants and others health care providers. It also provides incentives for professionals to send members of their immediate family to the health care giver that granted the courtesy (Bachrach, 2000). A perhaps more compelling reason for waiving or eliminating co-payments is that such practice can better ensure that economically disadvantage patients will more readily have access to medical care.

Statutory problems with Providing Professional Courtesy

As many third-party billing companies will attest, a number of physicians still offer some form of professional courtesy to physicians, family members, physician assistants, the indigent patients, nurses and others. In spite of the reality that both, private and federal companies have made it more obvious that these kinds of practices can form a state of crime or present a break of agreement, many providers continue to extend waivers and discount to their patients. Such conduct or practices may represent violations of the Federal False Claim Act (FFCA). The FFCA provides that anyone who knowingly submits a fraudulent or false claim for the fee to the government could be fined for around 5,500 dollars to 11,000 dollars on every claim that is false, and also for damages (Johnson, 2002).

The federal government has argued that a physician, or other health care provider should waive the cost-sharing amount due from a Medicare beneficiary, such an act may constitute the submission of a false claim to the government. Essentially, the government believes that such a waiver results in the “real amount of charges being misstated to Medicare”. Since Medicare is only supposed to pay a certain percentage of the allowable amount, it ends up paying more than it should have. To emphasize the government efforts to discourage this practice since 1991 the Health and Human Services Department issue “Special Fraud Alerts” publications emphasizes that the regular waiver of deductibles and or co-payment is corresponding to mis-stating the real charges given as payment to Medicare. As a result, such conduct may result in Federal False Claim Act (FFCA) ...