Handling Patient Financial Hardship
Author: Bob Burleigh
Healthcare Business Management Associates
The Issue
Compassion is a natural human response to a patient who cannot afford their medical bills. But in the billing context, well-intentioned actions — such as routinely waiving copays or deductibles — can cross into legal and ethical violations. The federal Anti-Kickback Statute and related regulations treat the routine or undocumented waiver of cost-sharing as a potential patient inducement, because it may influence a patient’s choice of provider in ways that affect federal healthcare programs. Assisting a provider who offers discounts, free products, rewards for referring other patients, and similar incentives are unethical and illegal for the provider, at unethical (at least) for billing company staff.
Why It Arises
Billing employees are often the first to hear from patients in financial distress. A patient calling to dispute a bill, request a payment plan, or simply express that they cannot pay puts the billing professional in a difficult spot. The instinct — and sometimes the explicit direction from providers — may be to “just write it off.” Without a formal financial adjustment and charity care process, however, this practice creates compliance risk for the organization and potential liability for the employee. Once again, employees handling these types of write-offs can encounter ethical challenges when the patients are related, known to them, or are coworkers.
The Ethical Responsibility
The ethical path here requires distinguishing between genuine, documented financial hardship programs and ad hoc waivers driven by convenience or favoritism. Billing employees should be familiar with their organization’s charity care and financial assistance policies and should direct patients to those processes rather than making informal exceptions. Compassion is appropriate — but it must be expressed within a framework that is consistent, documented, and compliant.