With respect to public health programs, Medicare providers are generally allowed to provide concierge services when the provider complies with Medicare rules and the conditions governing divestiture agreements, including the requirement not to charge additional fees to Medicare beneficiaries for services already covered by Medicare. Medicare`s concerns about concierge medicine and divestiture agreements are partially summarized in a 2004 Office of Inspector General Opinion warning entitled «OIG Alerts Physicians About Added Charges for Covered Services – Extra Contractual Charges Beyond Medicare`s Deducible, Coinsurance: A Potential Assignment Violation.» 4 As with private payers, Medicare continues to deter providers, That the concierge tax cannot include additional fees for items or services covered by Medicare.5 Medicare providers should also inspect federal authorities for civil fines, including the Beneficiary Incentives Act (BIS).6 The BIS prohibits Medicare providers from offering a Medicare or Medicaid recipient a salary that the person knows or knows about should know that it may influence the recipient`s choice of a particular provider7, while it is essential that Medicare recipients are not charged to Medicare recipients for a service or items covered by Medicare, it is also essential that Medicare recipients pay fair market value for all additional services or positions, so that providers can comply with the BIS. Michigan health care providers who practice or consider janitorial medications should be aware of the contractual and legal considerations that apply to janitorial medical practices. In a typical janitorial practice, patients pay an annual or retention fee for improved services or amenities, including, but not limited to, better access to doctors, longer appointments and better coordination of care with specialists. Concierge medicine offers health care providers the opportunity to focus on a smaller patient panel and offer more specialized care, while adding an additional revenue stream to compensate for the decrease in patient numbers. Concierge medicine also includes primary direct care, which is an alternative to cost-per-service service, where physicians charge patients a fee covering all or part of primary care. Finally, ethical guidelines should not be equated with the law, but providers should consider the ethical opinions and other guidelines of the American Medical Association (AMA) and the Michigan State Medical Society (MSMS) regarding the practices of concierge medicine8. If the patient cannot sign, the legal agent gives consent to the treatment. For the purposes of this agreement, the term «patient» includes all patient representatives authorized to make decisions and sign the agreement on behalf of the patient. Legal and regulatory issues are interconnected and require specialized supervision and may apply for physicians in the conventional medical field as well as in the complementary and alternative medical or well-being field. Sometimes our clients think they have a janitor care model, but it`s really a model of wellness care in which the patient contracts for certain services. In summary, Michigan health care can generally conclude with privately-owned patients and Medicare beneficiaries an agreement on janitorial medicine.
These agreements must be in accordance with federal and national law, as well as contractual agreements and other provisions applicable to third-party payers, providers and patients. The general rule is that janitorial fees should not be reimbursed to service or covered goods providers and providers should not discriminate against patients who do not enter into concierge agreements.