Increasingly, our healthcare and business law firm’s clients are interested in opening concierge medicine practices. Hamil Little’s last blog post provided an overview of what concierge medicine is with references to compliance risks. This post outlines those very serious compliance risks for practices that treat Medicare patients and are not opted out of Medicare. If you have questions regarding this blog post or starting a concierge practice, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, firstname.lastname@example.org. You may also learn more about our law firm by visiting www.hamillittle.com.
Understanding the compliance risks associated with concierge medicine practices requires understanding a fairly easy and, perhaps, obvious concept: Providers cannot bill patients for services paid for by their insurance; a practice referred to as “double billing.” Applying that concept is easier said than done. Consider the complexity in this: a concierge medicine practice requires a $200/month fee that includes “longer appointments,” which is a clear benefit to patients. Assuming the appointment itself is covered by insurance, is the fact that it’s longer something that insurance does not cover? Maybe, but maybe not. There are ample examples of how complex this question is and, as it relates to Medicare, CMS and the Office of Inspector General (“OIG”) offer minimal guidance.