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Potential Trouble When Providers Waive Copays or Deductibles
Holland & Hart LLP Link to more items from this source
July 14, 2014
"Providers sometimes waive patients' cost-sharing amounts (e.g., copays or deductibles) as an accommodation to the patient ... [or] employee benefit ... [D]oing so may violate fraud and abuse laws and/or payor contracts.... [P]ayors often contract with providers to pay based in part on the provider's usual charges. The Office of Inspector General has argued that a provider who routinely waives copays is misrepresenting its actual charges. Second, and more importantly, payors require copays to discourage overutilization and reduce costs. Waiving copays and deductibles removes the disincentive for utilization, thereby potentially increasing payor costs."

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