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Discounted sports physicals for local athletes

Compliance Monitor, July 29, 2005

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Q: In our area, medical clinics that are associated with hospitals-and hospitals themselves-are giving away free or heavily discounted sports physicals to area high school athletes. The chief financial officer of our hospital is concerned that this practice is a major compliance problem. How are these other facilities doing this? Is it something we can offer our local athletes without risking compliance violations?

A: Hospitals may sponsor community services such as sports physicals, educational events, info sessions, and health fairs. If the hospital wishes to include non-employed physicians, participation must be extended to all physicians in a particular specialty. The hospital may provide information about participating physicians such as the physicians' names, addresses, and phone numbers. Further, the services must be made available to all individuals to whom the service may apply. Medicare and Medicaid encourage patients to seek preventive care programs.

Price reductions or providing services for free in the environment of a community event or health fair is not considered a violation of the anti-kickback statute nor are they considered a beneficiary inducement as long as the discount and/or preventive care services safe harbors are met. For example, all sports physical patients should be charged the same amount for the service which is disclosed at the time of service. If claims for insurance are submitted, the discount should be properly disclosed and reported on the claim. Such discounts should also be accounted for on the hospital's cost report. (Reference: 42 U.S.C. 1320a-7b(b)(3)(A); 42 CFR 1001.952(h) and 42 CFR 1003.101).

The U.S. Preventive Services Task Force provides a comprehensive list of services that may be offered in the spirit of preventive care. This list can be found at

http://www.ahrq.gov/clinic/uspstf/uspstopics.htm

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