Five things every physician needs to know about freebies and discounts.

2. Offer Patient Discounts Only to Self-Pay Patients Discounts, such as prompt-pay and cash-up-front discounts, should not be given to insured patients in Wisconsin. Interestingly, the federal AKS allows legitimate discounts reflecting actual savings to the provider.5 However, such discounts would be considered a reduction or elimination of cost-sharing amounts, which are prohibited by Wis. Stat. §146.905 except in cases of financial hardship. The discounts could also violate Wisconsin’s insurance fraud law, Wis. Stat. §943.395, which could be avoided if the insurer was notified of the discount. However, nothing in Wis. Stat. §146.905 indicates that notice of the discount to the insurer will cure a violation, and that is why such discounts are not allowed in Wisconsin. Be wary of an unpublished 2004 Wisconsin Attorney General Opinion stating that prompt pay discounts are allowed under §§943.395 and 146.905, so long as the insurer is fully informed of the discount and the discount is offered without discrimination. The opinion rests on public policy and cannot be harmonized easily with the actual language in Wis. Stat. §146.905 and should not be relied on. So, the only patients who can be offered these types of discounts in Wisconsin are self-pay patients.6 However, even with self-pay patients, physicians must be careful of offering discounts so often or so large that they affect the physician’s “usual and customary” charge. This could lead to liability under the Wisconsin insurance fraud law7 as well as federal law, which allows OIG to exclude providers from Medicare or Medicaid if they submit bills for amounts that are “substantially in excess” of the their “usual charge.”8 Follow these rules for a compliant discount plan: • The discount must bear a reasonable relationship to the amount saved by the practice. • Offer the discount only to selfpay patients. • Do not advertise the discount.