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Illegal Inducements

Chiropractic discounts, the right way

The Patient Solicitation Anti-Inducement Provision Section 1128A of the Social Security Act, enacted as part of the Health Insurance Portability Act (HIPAA), provides for the imposition of civil monetary penalties against any person who offers or transfers to a Medicare or Medicaid beneficiary any remuneration that the person knows or should know is likely to influence the beneficiary’s selection of a particular provider, practitioner, or supplier of Medicare or Medicaid payable items or services, and may levy civil money penalties of up to $10,000 for each wrongful act.

“Remuneration” includes, without limitation, waivers of copayments and deductible amounts (or any part thereof)and transfers of items or services for free or for other than fair market value. (See section 1128A (I) (6) of the Act.). Of course there are provisions for those with financial hardship that has been properly verified, but that’s not what we’re talking about here.

Practices that routinely discount or provide services for free, outside of documented financial hardship, are in violation of this rule. This means you may not routinely discount statutorily non-covered services, such as exams, x-rays, therapies and durable medical equipment. It can be seen as an inducement to get them to come to your office in order to bill for the covered service, Chiropractic Manipulative Treatment.

It's our recommendation that providers join a Discount Medical Plan Organization (DMPO) such as ChiroHealthUSA in order to legally discount these items to its members. Medicare and other federally insured patients may join this DMPO to become eligible for discounted fee schedules offered through the network for their non-covered services.

Have questions? Book a 10 to 15 minute Quick Consult with one of KMC University's reimbursement and compliance experts to discuss your specific situation.

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