Fam Pract Manag. 2012 Jan-Feb;19(1):5.

Can I set fees below Medicare rates?

I read FPM's “Getting Paid” blog post about physicians' Medicare participation options. It has been my understanding that no Medicare-participating practice may set charges for other payers (or for individual patients) at rates that are less than the Medicare-approved charge. Is this true? Also, are there ways that physician practices may legally charge uninsured patients less without running afoul of Medicare rules and regulations?


No, it is not true. This is an unwarranted generalization related to the anti-kickback statute that prohibits charging Medicare patients less than the Medicare fee schedule, for instance by writing off deductible and coinsurance amounts, in order to influence them to buy more services. To read more about the anti-kickback statute and the routine waiver of co-payments or deductibles under Medicare, refer to the “Publication of OIG Special Fraud Alerts,” heading C. For uninsured patients, you can offer discounts without violating the anti-kickback statute. For more information, see https://www.aafp.org/fpm/2009/0900/p26.html.


Send your comments to fpmedit@aafp.org. Submission of a letter will be construed as granting AAFP permission to publish the letter in any of its publications in any form. We cannot respond to all letters we receive. Those chosen for publication will be edited for length and style.


Copyright © 2012 by the American Academy of Family Physicians.
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