Providers sometimes waive patients’ cost‐sharing amounts (e.g., copays or deductibles) as an accommodation to the patient. However, doing so may violate fraud and abuse laws and/or payor contracts. From a payor’s perspective, waiving cost‐sharing amounts creates two problems.

First, payors often contract with providers to pay based in part on the provider’s usual charges. The OIG has argued that a provider who routinely waives copays is misrepresenting its actual charges.

Second, payors require copays to discourage overutilization and reduce costs. Accordingly, federal and state laws as well as payor contracts generally prohibit waiving cost‐sharing absent genuine financial hardship.

Terry discusses the ins and outs of these policies and how to handle them in your practices.

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