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Prison For Failure To Collect Medicare Co-Payments?

By Robert David, Esq.

Medicare is not supposed to be free medical care. Medicare rules require an annual deductible and a 20% co-payment by patients for services under Medicare Part B. The co-payment is in part to defray costs and to hold down costs under the theory that if patients are paying some part of the fee out-of-pocket they are more inclined to scrutinize and object to excessive or unnecessary services or procedures. In many instances however, in sort of a wink and a nod, providers either do not charge a co-payment due to ?financial hardship? or bill patients for co-payments but fail to aggressively collect the payment. The Office of Inspector General (OIG) has previously issued guidance stating that the routine waiver of co-payments is a kickback and leads to fraud: Routine waiver of deductibles and copayments by charge-based providers, practitioners or suppliers is unlawful because it results in (1) false claims, (2) violations of the anti-kickback statute, and (3)excessive utilization of items and services paid for by Medicare...continue to full post

Full post as published by Health Care Fraud Blog on January 07, 2010 (boomark / email).