Fee splitting occurs when a patient is referred by one doctor to another in
return for a portion of the fee that the referral doctor receives for treating
the patient. Both the AMA and APA consider this practice unethical for a
number of reasons; primary among them is that fee splitting undermines patient
trust. A patient should be able to rely on his or her physician to make
referrals based only on the skill and quality of the physician to which the
patient is being referred. Moreover, fee splitting puts a physician at risk
for running afoul of federal and state antikickback laws.
Sometimes experienced physicians offer referrals to new physicians with
strings attached that might be construed as fee splitting. For instance, a
physician may be told that he or she can see patients using an office in the
referring physician's facility, but must pay a percentage of the fees received
to cover the overhead.
While there is nothing wrong with paying for the use of office space, the
cost should not be a percentage of the patient's charges; instead, it should
be a flat fee based on what is reasonable and customary for renting such space
in that location.
In one case that came to the attention of APA's Managed Care Help Line, the
referring physician stipulated that the new practitioner had to use his
billing service for the referrals. This practice is acceptable, provided the
fee charged by the billing service is reasonable and customary. Within a group
practice, members of the group can decide how fees will be allocated, and this
does not constitute fee splitting.
Fee splitting is a complex legal issue governed by both federal and state
laws. As a general rule, if it looks like fee splitting, don't do it. If you
have specific questions about whether a business arrangement you would like to
accept constitutes fee splitting, you should consult a lawyer familiar with
the laws in your state before making any agreements. ▪