Letters

Is discounting fees fraudulent?

To the Editor:

An answer in the April 2002 Ask FPM department ["Discounts for uninsured patients," page 60] recommended discounting fees for uninsured patients. It has been my understanding that discounted or waived fees or any "unequal" treatment of classes of patients is considered fraud by insurance companies, especially Medicare. Have I been misinformed on this matter?

Alan J. Frueh, MD
Sacramento, Calif.

"Sorry, Lance, it could never work! My father is a doctor, and yours runs a health plan."

Editor's response:

Medicare and other insurers expect that a practice will not discriminate in what it charges patients. That said, Medicare and other insurers recognize that what is actually collected will vary among patients based on the insurance they have. Thus, a practice may collect a different amount as payment in full for a Medicare patient than it does for a commercially insured patient, based on the terms of the payer's policy and fee schedule. In this respect, collecting an amount that is less than the actual charge for uninsured patients is no different and would not be seen as fraud. You should ensure that discounts are applied consistently to a given category of patients (e.g., all uninsured patients receive the same discount for paying up front in cash) and that any deviations (e.g., due to financial hardship or bad debt) are handled according to an established policy or procedure. Also, practices should not routinely waive co-payments, co-insurance or deductible amounts. Managed care plans typically require a good-faith effort to collect these amounts as part of the cost-sharing mechanism of the plan, and Medicare considers routine waiver of co-insurance and deductible amounts to be a potential kickback to the patient for receipt of services.

Kent J. Moore
AAFP

Great guide to error reduction

To the Editor:

FPM is to be congratulated for an outstanding July/August 2002 issue on avoiding errors in family practice. As a member of the Institute of Medicine (IOM) committee that produced the report To Err Is Human, I found this special issue of FPM a valuable follow-up. The IOM report could only use available data, which was all from hospitals. While important errors occur in primary care offices, no one has studied them systematically. This issue of FPM touches on the obvious choices for reducing errors in a family physician's practice: safer prescribing, lab and X-ray follow-up and communication. We now have information technology and systems of care that enable us to provide safer care. The changing standards of practice will soon make adopting safer tools and methods of care an imperative. FPM continues to guide the way for family physicians to adapt to a changing practice environment.

Joseph E. Scherger, MD, MPH
Tallahassee, Fla.

Quality resources for diverse populations

To the Editor:

While I applaud the intent of and much of the content in "Achieving a More Minority-Friendly Practice" [June 2002, page 39], it omitted two exceptional resources for family physicians, and was incorrect in some of its inferences.

The AAFP recently partnered with the federal government to create "Quality Care for Diverse Populations," an informational video and CD-ROM available for purchase at www.aafp.org/catalog or by calling 800-944-0000. Until I retired this year, I served as director of the Quality Center in the Bureau of Primary Health Care and my staff worked with the AAFP in this effort. We also developed "The Provider's Guide to Quality & Culture," available online at erc.msh.org/quality&culture.

Francis A. Zampiello, MD, FAAFP
Philadelphia

Editor's response:

If space limitations had permitted us to publish a list of resources with the article, it might well have included the two that you mention. Thank you for bringing them to our attention.