Can A New York Physician Waive Medical Fees?

Whether you are a family practitioner or a medical specialist in New York, in some cases, forgiving co-pays, co-insurance, and deductibles can be a legally dicey proposition. Though the waiver of these fees may endear you to your patients, insurance companies, including government-funded programs such as Medicare and Medicaid, do? not look kindly on such actions.

What you may think of as a kindness and a courtesy to your patients is viewed by insurance companies as a form of insurance fraud, placing you and your patients at risk for civil, regulatory, and potential criminal liability.

While some states do leave it to the physician’s judgment whether to waive a co-pay and/or co-insurance, this is not the case in New York. If a New York physician wishes to waive a fee, he or she must be very careful to avoid the many potential legal pitfalls.

Both government and private insurance companies frequently argue that waiving medical fees violates the law in one or more of the following ways:

The first theory is that the waiver is an improper inducement or kickback, used to induce patients to choose one particular provider over another, violating