Understanding the Legalities of Fee Discounts, Particularly Time-of-Service Discounts and Hardship Discounts

Course overview

Explain how to set chiropractic fees that cover expenses, generate profit, and comply with state and federal antitrust laws without surveying competitors. Differentiate the orthodontist prepayment model from improper insurance-fee practices such as charging insured patients more or routinely waiving copays. Describe the OIG-approved tiered prompt-payment discount structure and the limits that prevent it from circumventing copays and anti-kickback rules. Analyze the risks membership discount plans pose to patients when services are uncertain and doctors leave the plan. Identify Utah's regulatory safeguards for health discount programs, including licensing, refund policies, and required non-insurance disclaimers. Evaluate when hardship discounts are permissible and how routine copay waivers can trigger False Claims Act liability. Describe False Claims Act provisions, including penalties, whistleblower suits, and the standard of deliberate ignorance or reckless disregard. Differentiate lawful prepaid treatment arrangements from prepaid plans that cross into regulated insurance territory. Explain how fee splitting and the corporate practice of medicine doctrine are affected by ERISA preemption of state laws. Recognize conduct prohibited under the federal anti-kickback statute, including non-cash items of value exchanged for patient referrals. Describe Stark Law self-referral prohibitions and the designated health services covered under Stark II. Analyze how Groupon-style percentage-based marketing arrangements may constitute illegal fee splitting or kickbacks under state law.