May 7, 2013

For those paying attention to marketing trends, practitioners have been risking exposure (knowingly or unknowingly) but signing on and marketing through Groupon because of Groupon's fee structure - to take a percentage of vouchers sold for services - also known as, taking an illegal fee split of fees.  Many of us in the community, our office included, have been banging our heads against the wall and phone communicating with Groupon's and Living Social's legal departments, sales reps, etc., explaining NYS laws regarding fee splitting.  Finally, we are seeing movement!!!  Groupon is NOW offering a flat fee contract, where the fee has no correlation to vouchers sold and there is no "fee split".  Now, this does not mean you should all be running to sign up.  The fee splitting contracts are still out there.  Be sure when you do inquire you make sure you are signing an appropriate document by having it reviewed by your healthcare attorney.


Hi Jennifer

Have enjoyed your emails -- thanks so much.

I have a question for you -- it is based on a recent incident.

I had a patient who financed her surgery through Care Credit, which is a company that loans money to patients for cosmetic surgery.  The patient arranged for the Care Credit loan directly, with no input from my office other than the recommendation itself.  Apparently she did not know or understand the terms of the agreement with Care Credit and had a dispute with them as regards the interest rate. She was obviously unsuccessful in her argument with them over this point.  She then  claimed to them that she was disappointed in the results of the surgery and wanted her money back -- and in fact, Care Credit did deduct the funds from my account (without me knowing that fact until after it had been done).  This all occurred 19 months after the surgery -- and the surgery, BTW, was successful.  In essence, she tried to undo the loan by blaming me.

When I was notified of this, I immediately wrote to Care Credit and explained that this was for "professional services" and that there can be "no return of merchandise" in case the buyer is disappointed -- the professional services cannot be treated in this way.  I also explained a bit about the patient's successful surgery -- and indeed I won and the money was returned to me.

The crux of my question is this:  In the future, I would like to provide a paragraph of information on my patient intake sheet (a copy of which would be provided to the patient) in which the patient would surrender or waive their privacy rights (ie HIPAA rights) if they dispute the charges with a credit card company, loan company or any other money lending agency.  Otherwise, the patient could accuse me and I would not be able to provide information to defend myself.  

How should I phrase this paragraph?  How could I protect myself in this situation in the future?

Dr. D


Sticky sticky stuff!  To directly answer your question, if you are utilizing a properly drafted Notice of Privacy Policy your policy should have a clause stating you are authorized to make "minimum necessary" disclosures for "payment purposes".  Now, that provision is not truly meant for disputes with credit companies, moreso for insurance disclosures, however, technically it would cover you for a disclosure to Care Credit. More applicable than the release of patient information would be a financial policy implemented in your practice that patients are required to sign whereby the patient acknowledges they are financially responsible for all services rendered.  You may even want to include that such financial responsibility applies for any and all services performed, regardless of outcome. 

As a general concern should you elect to release patient information a third party such as a credit lender or financing company, even with patient permission, be sure to have in place a proper business associate agreement before any release of protected health information.  Failing to do so may leave you exposed should the third party misuse the information. 

Glad to hear you recouped money well earned!  Should you have issues collecting in the future, feel free to contact me to discuss our collections practice. 

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