Great caution should be exercised in granting professional courtesy, either directly or in the form of a waiver of co-payments and deductibles. There are no clear-cut guidelines in this area, but pathologists who extend professional courtesy should be aware of several potential pitfalls.

The waiver of co-payments in cases of financial hardship is appropriate when the co-payment acts as a barrier to needed care. However, waiving co-payments or deductibles on a regular basis may be construed as misstating physician charges with implication for insurance fraud and abuse. The failure to regularly bill for co-payments or deductibles for a specific physician or group of physicians, or extending professional courtesy to a referring physician, may also be interpreted as an inducement for a referral and subject to civil penalties by Medicare and Medicaid. Moreover, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) allows for criminal sanctions and grants the Inspector General and the Attorney General the authority to investigate fraud and abuse in claims submitted to private health plans, as well as to government programs.

It is unlikely that the extending of professional courtesy on an isolated basis would be construed as fraudulent, but care and judgment should be exercised.

For additional discussion, see the summary of the American Medical Association's Board of Trustees Report 18-A-98 on Professional Courtesy and Health Care Fraud and Abuse.