Which of the following is true about waiving Medicare patient copayments?
Asked by: Sabrina Gislason | Last update: March 11, 2025Score: 4.6/5 (73 votes)
Can Medicare copays be waived?
B.
copayments or deductibles directly from the patient. Any waiver or reduction of Medicare coinsurance or deductible amounts that do not strictly comply with the above policy standards are subject to potential criminal and civil sanctions and are strictly prohibited by this policy.
Why the physician is not allowed to waive a co pay for a patient?
While it seems like waiving copays is good for patients, the Government takes a different view. Routinely waiving copays can violate the Anti-Kickback Statute and the False Claims Act. These violations can lead to lawsuits worth millions of dollars to the government and whistleblowers.
What does the practice of routinely waiving deductibles or copayments violate?
In cases involving the Department of Justice, the powers that be have stated very clearly that the practice of routinely waiving deductibles and copays can be a violation of the Federal Anti-Kickback Statute.
Is it permissible to routinely waive co-payments from patients as a customer service courtesy?
Conclusion. So, providers can, under certain circumstances waive or discount patient co-payments. But remember, from a legal standpoint, routinely offering discounts to patients is a risky venture. It can implicate various state and federal laws, and can attract the scrutiny of government investigators.
What is Your Medicare Part B and Coinsurance Amount? 🤔
What does it mean when a copay deductible is waived?
In these cases, you may see certain services on your plan that say “deductible waived” or “deductible does not apply.” This means you'll pay the expense, but the payment won't get you closer to reaching your deductible.
Can a doctor refuse to treat a patient if they can't pay?
Some medical providers may consider refusing to treat because of the patient's inability to pay for treatment. Generally, in non-emergency situations, this is allowed. A private internist, for example, might refuse to schedule a patient's appointment if that patient has unpaid medical bills.
What is an example of a Stark law violation?
What Are Stark Law Violation Examples? To give an example, let's say a physician invests in a freestanding lab diagnostics center and refers their patients, with Medicare, to that lab center for bloodwork. Whether or not they intended to benefit from the referrals, the physician would appear to violate the law.
Can you waive Medicare coverage?
How do I terminate my Medicare Part B (medical insurance)? You can voluntarily terminate your Medicare Part B (Medical Insurance). However, you may need to have a personal interview with us to review the risks of dropping coverage and for assistance with your request.
Do Medicare patients have to pay a copay?
Medicare Part A has a copayment for inpatient care after a person has been in the hospital for a certain amount of time. Medicare Advantage and Medicare Part D also have copayments.
Can pharmacy waive copay?
To waive your copay: Pharmacies are not allowed to routinely waive their copays for people without Extra Help, but your pharmacist can waive copays on a case-by-case basis. Tell your pharmacist you cannot afford the copay, and request that it be waived.
What is the anti-kickback law for Medicare?
The AKS is a criminal law that prohibits the knowing and willful payment of "remuneration" to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients).
What is an example of a violation of the False Claims Act?
Examples of actions that could violate the federal FCA include overcharging the government for services rendered; filing a claim with the government for services that were not rendered; or filing a claim with the government with information known to be false.
What is the Stark Law for physicians?
The Stark regulations allow nonmonetary compensation to physicians from a referred to entity as long as the compensation is in the form of items or services rather than cash or cash equivalents and does not exceed an aggregate value of $300 per year.
Can a hospital turn you away if you can't pay?
Because of EMTALA, you can't be denied a medical screening exam or treatment for an emergency medical condition based on: If you have health insurance or not. If you can pay for treatment.
Can I sue my doctor for not treating my pain?
The simple answer is yes. A physician may be sued for pain and suffering and other damages. Such a lawsuit typically arises in a medical negligence case, also known as a medical malpractice action, discussed below.
Can a doctor refuse to treat a Medicare patient?
Physicians may either agree to be a participating provider or non-participating provider. Providers who do not want to enroll in Medicare or receive Medicare payments are required to sign an “opt out” agreement with their patients.
Can you waive a Medicare copay?
Risks for Waiving Co-Pays Under Medicare and Medicaid.
Routinely or regularly waiving co-pays for Medicare or Medicaid patients poses several potential problems for your practice. Because both Medicare and Medicaid are federally funded programs, you risk violating multiple federal laws.
Why is waiving copays illegal?
Waiving copays and deductibles removes the disincentive for utilization, thereby potentially increasing payor costs. Accordingly, federal and state laws as well as payor contracts generally prohibit waiving cost-sharing absent genuine financial hardship.
What to do if a patient asks you to waive the deductible?
The only legitimate reason to waive co-pays and deductibles is the patient's genuine financial hardship. Documentation in patients' own handwriting must include income; assets; expenses, including the local cost of living; family size; and the extent of their medical bills.
Is waiving deductibles illegal?
Deductibles. It is illegal for a contractor to pay, waive, or discount your insurance deductible. It is insurance fraud if homeowners don't pay their deductible. Some contractors offer waived or discounted deductibles as a selling point to their customers.
What is an example of an anti kickback statute?
Examples of prohibited kickbacks include receiving financial incentives for referrals, free or very low rent for office space, or excessive compensation for medical directorships. Other kickbacks include waving copayments, either routinely or on a selective case-by-case basis.
Can a doctor collect a Medicare deductible upfront?
If a beneficiary shows that the Part B deductible is met, the provider will not request or require prepayment of the deductible. Except in rare cases where prepayment may be required, any request for payment must be made as a request and without undue pressure.
Which of the following is an example of a kickback?
Any gift of above nominal value, including things such as food, event tickets, and gift cards, is an improper kickback. If the purpose of giving the gift is to induce or reward referrals or preferential treatment for goods or medical services, this is considered a kickback.