Waiving Patient Balances: Co-insurance, Deductibles and CC Payment



Waiving patient cost share responsibilities, including deductibles, coinsurance, and cc payments, carries significant legal risks for healthcare professionals. Both Federal and commercial healthcare programs and plans impose civil and criminal liability in case of non compliance. It is essential for healthcare professionals to grasp the intricate legal framework, rules and potential penalties associated with the waiver of patient cost share responsibilities today’s healthcare landscape, understanding these complex regulations is imperative to protect both patients and medical practices. Failure to comply can lead to severe consequences, including legal actions, fines, and damage to professional reputation. Healthcare professionals must navigate the fine line between providing financial assistance to patients in need and adhering to strict legal requirements.

This session by federal licensed attorney, Thomas J. Force, ESQ. aims to shed light on these critical aspects. Thomas will delve into the nuances of the Federal False Claims Act and Anti Kickback statutes, exploring their defined penalties and implications for healthcare providers. Additionally, he will discuss practical strategies for drafting policies that align with financial hardship, professional courtesy and prompt payment, while staying within the bounds of the law.

Learning Outcomes:
  • Gain a comprehensive understanding of the hazards associated with waiving patient cost share responsibilities
  • Learn why is waiving patient cost show responsibility so important
  • Understand the Federal False Claims Act liability & penalties
  • Know the Anti kick back liabilities and associated penalties
  • Know the Impact of Federal health programs versus commercial health plans
  • Health Plan sample language
  • Learn how to analyze health plan documents relative to the prohibits of waiving patient cost share basis
  • Know about professional courtesy, financial hardships, and prompt payment discounts and how to draft these documents compliantly
  • The reasons why the routine waiving patient cost share is dangerous
Areas Covered in the Session:
  • Importance of waiving patient cost show responsibility
  • Federal False Claims Act liability & penalties
  • Anti-kickback liabilities
  • Federal health programs versus commercial health plans
  • Health plan sample language
  • Analysis of legal cases
  • Professional courtesy
  • Financial hardships
  • Prompt payment discounts
  • The reasons why the routine waiving patient cost share is dangerous
  • Federal False Claims Act defined with penalties
  • The Anti Kick Back statutes defined with penalties
  • Drafting a complaint financial hardship, professional courtesy and prompt payment policy
  • Analyze typical health plan documents relative to the prohibits of waiving patient cost share basis
  • Live Q&A session
Recommended participants:
  • Healthcare CEOs
  • Healthcare CFOs
  • Healthcare COOs
  • Healthcare Provider Revenue Cycle Staff
  • Healthcare provider Office Managers and Billing Staff and Companies
  • Healthcare Compliance Personnel
  • Healthcare Attorneys
  • Physicians
  • Physician Assistants
  • Nurse Practitioners
  • Surgeons
  • Hospitals and Other Facilities
  • Insurance Companies
  • Healthcare Consultants
  • Practice Manager
  • In and Out of Network Providers
  • Medical Billing Companies
  • Providers Office Staff
  • Chief Compliance Officers
  • Medical Providers
  • Attorneys and Legal Staff
  • Customer Service Managers
  • Risk Managers
Presenter Biography:

Thomas J. Force, ESQ., is a state and federally licensed attorney with over 34 years of experience in the healthcare and insurance industries. As a former U.S. Marine and a successful Wall Street insurance litigator, Mr. Force served as General Counsel for a New York-based Accident and Health Insurance Company, where he also served as Chief Compliance Officer. These experiences led to the founding of The Patriot Group.

Mr. Force is a nationally recognized expert in revenue collection techniques, appeal strategies, and healthcare compliance. He is on the Advisory Board at Hunter Business School, a New York-based school for medical billing and coding students.

Mr. Force is an active member and frequent speaker on managed care and collection techniques for the Health Finance Management Association, several state medical associations, and other healthcare organizations.

On March 29th, 2022, Thomas J. Force, J.D, ESQ., President of The Patriot Group, served as moderator for the forum on Clinical Denial Management at Hofstra University, organized by the Health Finance Management Association – Metropolitan Section.

Additional Information:

After registration, You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:
  • Internet Speed: Preferably above 1 MBPS
  • Headset: Any decent headset and microphone which can be used to talk and hear clearly
Can’t Listen Live?

No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact: Toll-Free No: +1 800-757-9502 Email: cs@waymoreeducation.com