RISK 119

Course overview

*Assess state, federal and board rulings regarding fee discounts, particularly time-of-service discounts and hardship discounts, and the extent to which they may be impacted by anti-kickback legislation, insurance regulations, self-referral laws, marketing restrictions, and the tenets of unprofessional conduct. *Identify potential problems associated with routine approval of hardship discounts and the requirement for inquiry and documentation regarding qualifying for same. *Distinguish between appropriate and inappropriate/illegal marketing relating to fees and professional services. *Demonstrate how these discounts are regarded by relevant professional boards, and state and federal enforcement agencies. *Explain terms associated with time of service discounts and relevant factors associated in calculating an appropriate reduction in fees. *Identify specific conduct and activities within the practice of healthcare that violate a host of regulatory and statutory proscriptions relating to pre-paid fee arrangements. *Explain the development of current fee discounting legislation, rules and holdings. *Distinguish between appropriate and inappropriate/illegal marketing relating to fees and professional services. *Demonstrate a working knowledge regarding the roles played by the various state and federal enforcement agencies as they related to fee splits and kickbacks. *Assess one's working knowledge regarding the process by which state and federal rulings regarding fees impact a healthcare provider's practice in light of marketing, fee-splitting and anti-kickback legislation, insurance regulations, self-referrals, and the tenets of unprofessional conduct generally. *Verify how certain discount practices may be legally actionable as "improper inducements." *Evaluate federal Stark legislation and the discouragement of corruption in sound professional healthcare decision-making. *Identify distinctions between federal anti-kickback and the federal Stark legislation. *Critique state anti-kickback laws. *Recognize the role the FTC played, and continues to play, in discouraging the fraudulent marketing of discount health care programs. *Draw associations between co-pay requirements, consumer habits and federal healthcare expenditures. *Assess how "professional courtesy" discounts may raise enforcers' concerns under the federal anti-kickback statute. *Diagram how prepaid fee arrangements often resemble health insurance to unwitting patients. *Illustrate pitfalls that advertising discounts visit on the practitioner.