Can A Doctor Waive A Copay?

Many insurance companies require patients to make a copay when the insurance pays for certain medical bills.

Co-pays can be burdensome for patients.

But the government views them as an important part of Medicare.

As a result, routine copay waiver is illegal and results in criminal and civil penalties..

Can a medical provider waive copay?

A provider who routinely discounts or waives a patient’s copayment or deductible (collectively referred to as copayment) obligations, for example, can run afoul of the federal antikickback statute, 42 U.S.C. § 1320a-7b, or be accused of false billing by private insurance carriers not receiving the discount.

Can you be billed a copay?

Patients with health insurance: Must pay all copays when they check in. You cannot be billed for copays.

Are doctors required to collect copays?

Generally, both government and private insurers require that the practice make a good faith effort to collect co-pays from patients. HHS’ 1994 Special Fraud Alert noted that providers need to make good faith efforts to collect co-pays, apart from the cases of special financial needs of certain patients.

Do doctors have to collect copays?

For example, where the Medicare and Medicaid programs require patients to pay copays for services, you are generally required to collect that money from your patients. Routinely waiving these copays could implicate the AKS and you may not advertise that you will forgive copayments.”

Why is the physician not allowed to waive a copay?

Patients are responsible for copayments and deductibles. When providers routinely waive co-insurance requirements, it is unlawful because it results in: 1) false claims, 2) violations of the federal Anti-Kickback Statute, and 3) excessive use of items and services paid for by Medicare.