By Eric van Doesburg, MP Cloud Technologies
In an industry whose sole focus is to help those in need, it’s natural for us to want to assist patients financially when they’re in hardship situations.
Waiving deductibles and copays for patients that have either claimed poverty, or simply for bills that seem too small to make a difference has become common practice. Although this is well-intentioned, it can easily put your company in harm’s way.
“There is no question of if Medicare will audit you, but when.”
The Federal False Claims Act requires businesses to bill patient’s copays and deductibles unless the company puts in place a clearly defined, legally binding policy. Without such a
policy, any actions taken in regard to waiving payments would effectively overbill Medicare, leading to Medicare auditing the company for payment as well as instituting
additional penalties. And in this day and age, there is no question of if Medicare will audit you, but when.
You can still help out the less fortunate while working within the letter of the law, but only with the proper Financial Hardship Policies put into practice. We urge you to seek legal counsel when crafting
and adopting a hardship policy, however, be sure to consider the following points as you get started:
- Make it clear that you are not offering kickbacks: Clearly state in your guidelines that you do not offer incentives, such as kickbacks, bribes, rebates, or waivers of copayments or deductibles, for anyone bringing your company business.
- Define your threshold for financial hardship: There is no true definition of financial hardship; every case is different. Most standards suggest waiving copayments and deductibles for patients with a gross family income at or below 200% of the federal poverty guidelines. Your definition should be updated annually to ensure effective practices.
- Assign a decision-maker: Granting waivers involves state and federal anti-fraud laws, so a compliance officer or administrator would be best suited to assign who is exempt and who is not.
- Require Documentation: A valid documentation trail is required as evidence for a patient who claims financial hardship, such as W-2 forms, pay stubs, tax returns, or unemployment compensation.