Re-Thinking Professional Courtesy Financial, legal and ethical pressures are all bearing down on the once common practice of extending free medical care to colleagues and their families. A recent New England Journal of Medicine study on professional courtesy indicated that 96% of physicians practiced it in some fashion, either by providing free or discounted care, or by billing for “insurance only” – without collecting the co-payment. While that study is six years old, more recent discussions indicate that the practice may be dwindling rapidly, for a number of reasons. First, the routine waiver of co-payment is considered potentially fraudulent under a number of federal and state laws and regulations. Second, the changing practice of medicine works against preserving professional courtesy. For example, a sizeable professional courtesy practice could be financially burdensome. Third, there seems to be little need for the practice. The tradition began at a time when insurance was not common. The largest threat to survival of professional courtesy, however, is the legal climate. Most vulnerable is the relatively common practice of billing the insurer without collecting the co-payment-- a practice that can cause a physician to run afoul of several laws. Federal regulations state that “discounts and professional courtesy may not be appropriate unless the total fee is discounted or reduced. In such circumstances, the payer, (e.g., Medicare, Medicaid or any other private payer) shall receive its proportional share of the discount or reduction.” Professional courtesy can also be construed as a violation of the federal anti-kickback laws, if there appears to be a link between care provided and referrals of Medicare or Medicaid patients. The Office of the Inspector General says, however, that the routine practice of waiving the entire fee in the professional courtesy context is generally not a problem as long as the intent is not to induce referrals. Professional courtesy, once revered as a means to foster a sense of community and professionalism among colleagues, is on the decline. Return to Contents | Return to Billing Compliance