Paying for Referrals-Fee splitting

Fee splitting prohibitions are aimed primarily at situations where a healthcare professional, in order to generate patient referrals from other licensed or unlicensed persons, splits part of the professional fee earned from treating the referred patient with the source of the referral. In response to legitimate concerns, states adopted prohibitions against fee splitting. reference

American Association of Dental Boards: Guidelines of Advertising

Federal Anti-Kickback laws. This law is a broad prohibition of offer, solicitation, payment or receipt of anything of value, direct or indirect, overt or covert, in cash or in kind, intended to induce referral of patient for items or services reimbursed by all federal programs, including Medicare, Medicaid, and programs covering veterans’ benefits. See Social Security Act § 1128B. Remuneration is anything of value including money, rebates and free services. Both the offeror and recipient of a kickback violate the law. A kickback can exist if one purpose of the payment is to induce referrals, regardless of the legitimate reason for the payment. Reference here

§ 34-9-18. Grounds for disciplinary action (9) Is guilty of division of fees, or agreeing to split or divide the fee received for dental service with any person for bringing or referring a patient without the knowledge of the patient or his or her legal representative, except the division of fees between dentists practicing in a partnership and sharing professional fees, or in case of one licensed dentist employing another.

ARTICLE 3. UNLAWFUL ACTS. Section 315. Grounds for discipline, suspension or revocation of license 317. Civil fine authority 320. Summary license suspension 340. Penalties Sec. 08.36.315. Grounds for discipline, suspension or revocation of license.

(4) received compensation for referring a person to another dentist or dental practice;

32-1201.01. Definition of unprofessional conduct 11. Dividing a professional fee or offering, providing or receiving any consideration for patient referrals among or between dental care providers or dental care institutions or entities. This paragraph does not prohibit the division of fees among licensees who are engaged in a bona fide employment, partnership, corporate or contractual relationship for the delivery of professional services.

Article X: UNPROFESSIONAL CONDUCT DEFINED I. The receiving of anything of value as a referral fee, a fee splitting, a commission, or rebate, when professional services have not been rendered by the licensee.

(aa) Participating in or operating any group advertising and referral services that are in violation of Section 650.2. 650. (a) Except as provided in Chapter 2.3 (commencing with Section 1400) of Division 2 of the Health and Safety Code, the offer, delivery, receipt, or acceptance by any person licensed under this division or the Chiropractic Initiative Act of any rebate, refund, commission, preference, patronage dividend, discount, or other consideration, whether in the form of money or otherwise, as compensation or inducement for referring patients, clients, or customers to any person, irrespective of any membership, proprietary interest, or co-ownership in or with any person to whom these patients, clients, or customers are referred is unlawful.

§ 12-35-129. Grounds for disciplinary action. (t) Employing a solicitor or other agent to obtain patronage, except as provided in section 12-35-137; (v) Sharing any professional fees with anyone except those with whom the dentist or dental hygienist is lawfully associated in the practice of dentistry or dental hygiene; except that a licensed dentist or dental hygienist may pay an independent advertising or marketing agent compensation for advertising or marketing services rendered by the agent for the benefit of the licensed dentist or dental hygienist, including compensation that is based on the results or performance of the services on a per-patient basis;

Sec. 20-124a. Dental referral services: Disclosure of acceptance of fee for referral required. It shall be an unfair or deceptive trade practice, in violation of chapter 735a, for any person, firm, partnership, association, corporation or agent or employee thereof that engages in for profit, any business or service that in whole or in part includes the referral or recommendation of persons to a licensed dentist or dental practice for any form of dental care or treatment, to fail to disclose to a prospective patient, at the time the prospective patient makes initial contact by any means including advertising with the for profit business or service, that the licensed dentist has paid a fee for such referral.

12.0 Unprofessional Conduct Defined: 12.2.23 Failing to report unprofessional conduct by another licensee

4213.42 A dentist shall not accept or tender rebates or split fees

456.054 Kickbacks prohibited.—

(1) As used in this section, the term “kickback” means a remuneration or payment, by or on behalf of a provider of health care services or items, to any person as an incentive or inducement to refer patients for past or future services or items, when the payment is not tax deductible as an ordinary and necessary expense.

(2) It is unlawful for any health care provider or any provider of health care services to offer, pay, solicit, or receive a kickback, directly or indirectly, overtly or covertly, in cash or in kind, for referring or soliciting patients.

(3) Violations of this section shall be considered patient brokering and shall be punishable as provided in s. 817.505.

History.—s. 8, ch. 92-178; s. 2, ch. 96-152; s. 79, ch. 97-261; s. 8, ch. 99-204; s. 78, ch. 2000-160; s. 6, ch. 2006-305.

Note.—Former s. 455.237; s. 455.657.

Rule 150-8-.02 Fee Splitting

(1)

A dentist shall not give rebates or split fees with a referral source.

§448-17 Refusal, revocation, suspension, and administrative penalties. (a) The board shall refuse to issue a license to any applicant who fails to meet all of the requirements imposed by this chapter and may refuse to issue a license to any applicant who has previously committed any act that would, if committed by a licensee, result in the revocation or suspension of the license. (b) In addition to any other actions authorized by law, the board may suspend or revoke any license issued under this chapter and may fine a licensee for any cause authorized by law, including but not limited to the following: (1) Fraud in procuring license; (2) Habitual intoxication or addiction to the use of drugs; (3) Wilful or repeated violations of the rules of the department of health; (4) Acceptance of a fee for service as a witness, without the knowledge of the court, in addition to the fee allowed by the court; (5) Division of fees or agreeing to split or divide the fees received for dental services with any person for bringing or referring a patient; (6) Assisting in the care or treatment of a patient, without the knowledge of the patient or the patient's legal representative; (7) Employing, procuring, inducing, aiding, or abetting a person not licensed as a dentist to engage in the practice of dentistry; (8) Making any misrepresentations or false promises, directly or indirectly, to influence, persuade, or induce dental patronage; (9) Professional connection or association with, or lending one's name to another for, the illegal practice of dentistry by another, or professional connection or association with

04. Dividing Fees. A dentist shall not divide a fee for dental services with another party, who is not a partner or associate with him in the practice of dentistry, unless: (7-1-93) a. The patient consents to employment of the other party after a full disclosure that a division of fees will be made; (7-1-93) b. The division is made in proportion to the services performed and responsibility assumed by each dentist or party

Sec. 23. Refusal, revocation or suspension of dental licenses. The Department may refuse to issue or renew, or may revoke, suspend, place on probation, reprimand or take other disciplinary or non-disciplinary action as the Department may deem proper, including imposing fines not to exceed $10,000 per violation, with regard to any license for any one or any combination of the following causes:

        5. Division of fees or agreeing to split or divide

the fees received for dental services with any person for bringing or referring a patient, except in regard to referral services as provided for under Section 45, or assisting in the care or treatment of a patient, without the knowledge of the patient or his or her legal representative. Nothing in this item 5 affects any bona fide independent contractor or employment arrangements among health care professionals, health facilities, health care providers, or other entities, except as otherwise prohibited by law. Any employment arrangements may include provisions for compensation, health insurance, pension, or other employment benefits for the provision of services within the scope of the licensee's practice under this Act. Nothing in this item 5 shall be construed to require an employment arrangement to receive professional fees for services rendered.

153.32 Unprofessional conduct. As to dentists and dental hygienists “unprofessional conduct” shall consist of any of the acts denominated as such elsewhere in this chapter, and also any other of the following acts: 1. Receiving any rebate, or other thing of value, directly or indirectly from any dental laboratory or dental technician. 2. Solicitation of professional patronage by agents or persons popularly known as “cappers” or “steerers”, or profiting by the acts of those representing themselves to be agents of the licensee. 3. Receipt of fees on the assurance that a manifestly incurable disease can be permanently cured. 4. Division of fees or agreeing to split or divide the fees received for professional services with any person for bringing or referring a patient or assisting in the care or treatment of a patient without the consent of said patient or the patient’s legal representative. 5. Willful neglect of a patient in a critical condition.

65-1436. Grounds for refusal to issue license or for action against license of dentist or dental hygienist; disciplinary action by board; notice and hearing; professionally incompetent defined; physical or mental examination.

(7) engaged in the division of fees, or agreed to split or divide the fee received for dental service with any person for bringing or referring a patient without the knowledge of the patient or the patient's legal representative, except: (A) The division of fees between dentists practicing in a partnership and sharing professional fees; (B) the division of fees between one licensed dentist employing another; or (C) the division of fees between a licensed dentist and a dental franchisor;

§775. Unprofessional conduct defined. (7) Directly or indirectly offering, giving, receiving, or agreeing to receive any fee or other consideration to or from a third party for the referral of a patient in connection with the performance of a dental service.

Causes for non-issuance, suspension, revocation, or imposition of restrictions of dental hygienist license. (19) Employing solicitors or subsidizing anyone, or paying or presenting any person money or anything of value for the purpose of securing patients, except as allowed by R.S. 37:775.

§776. Causes for non-issuance, suspension, revocation, or imposition of restrictions of dental license (9) (a) Division of fees or other remuneration or consideration with any person not licensed to practice dentistry in Louisiana, or an agreement to divide and share fees received for dental services with any non-dentists in return for referral of patients to the licensed dentists, whether or not the patient or legal representative is aware of the arrangement.

§777. Causes for non-issuance, suspension, revocation, or imposition of restrictions of dental hygienist license (17) The use of advertising without disclosing the name and address of the licensed dentist under whom the dental hygienist operates as defined in R.S. 37:766.

II. UNPROFESSIONAL CONDUCT Unprofessional conduct under 32 M.R.S.A. §1077(2)(F) includes, but is not limited to, the following:

D. Division of fees or an agreement to split the fees received for dental services with any person for referring a patient or for assisting in the care of a patient, without the knowledge of the patient or the patient's representative.

(8) Paying or accepting fees in any form or manner as compensation for referring patients to any person for professional services, radiograms, written work orders, or other services or articles supplied to the patient is prohibited.

3100.6200 CONDUCT UNBECOMING A LICENSEE.

"Conduct unbecoming a person licensed to practice dentistry, dental therapy, dental hygiene, or dental assisting, or conduct contrary to the best interests of the public," as used in Minnesota Statutes, section 150A.08, subdivision 1, clause (6), shall include the act of a dentist, dental hygienist, licensed dental assistant, or applicant in:

A. engaging in personal conduct that brings discredit to the profession of dentistry;

B. gross ignorance or incompetence in the practice of dentistry or repeated performance of dental treatment that falls below accepted standards;

C. making suggestive, lewd, lascivious, or improper advances to a patient;

D. dentists charging a patient an unconscionable fee or charging for services not rendered;

E. performing unnecessary services;

F. dental therapists, hygienists, or licensed dental assistants performing services not authorized by the dentist under this chapter or Minnesota Statutes, chapter 150A;

G. accepting rebates, split fees, or, applicable to dentists only, commissions from any source associated with the service rendered to a patient; provided, however, that the sharing of profits in a dental partnership or association, or dental professional firm approved by and registered with the board, shall not be construed as splitting fees nor shall compensating allied dental personnel on the basis of a percentage of the fee received for the overall service be deemed accepting a commission;

3100.6900 CONSIDERATION FOR PATIENT REFERRAL.

A person shall not directly or indirectly offer, give, receive, or agree to receive any fee or other consideration to or from a third party for referral of a patient in connection with the performance of professional services.

Statutory Authority: MS s 150A.11; 214.15

Published Electronically: September 30, 2010

BOARD REGULATION NUMBER 43--ADVERTISING j. Directly or indirectly offers, gives, or agrees to receive any fee or other consideration to or from a third party for the referral of a patient in connection with the performance of professional services.

24.138.413 REBATE AND SPLIT FEES

(1) Licensees shall refrain from accepting or tendering "rebates" or "split fees", which are commissions paid to others for referral of business.

002.03 Referral of Patient. Directly or indirectly offering, giving, receiving, or agreeing to receive any fee or other consideration to or from a third party for the referral of a patient in connection with the performance of professional services is prohibited.

d) Dentists shall not receive, solicit, offer or pay any remuneration as an inducement to make a referral or as compensation for a referral of a patient for a service, product, drug or device or to purchase, prescribe or recommend a product, drug or device. Nothing contained in this section shall prohibit a licensee from paying the reasonable costs of any advertisement permitted pursuant to N.J.A.C. 13:30-6.1 and 6.2. Nothing contained in this section shall prohibit a dentist from providing a gift to a patient, or from providing a credit for dental services to a patient, provided the gift or credit does not exceed $25.00 in value

§6509-a Additional definition of professional misconduct; limited application.

Notwithstanding any inconsistent provision of this article or of any other provision of law to the contrary, the license or registration of a person subject to the provisions of articles one hundred thirty-two, one hundred thirty-three, one hundred thirty-six, one hundred thirty-seven, one hundred thirty-nine, one hundred forty-one, one hundred forty-three, one hundred forty-four, one hundred fifty-six, one hundred fifty-nine and one hundred sixty-four of this chapter may be revoked, suspended or annulled or such person may be subject to any other penalty provided in section sixty-five hundred eleven of this article in accordance with the provisions and procedure of this article for the following:

That any person subject to the above enumerated articles, has directly or indirectly requested, received or participated in the division, transference, assignment, rebate, splitting or refunding of a fee for, or has directly requested, received or profited by means of a credit or other valuable consideration as a commission, discount or gratuity in connection with the furnishing of professional care, or service, including x-ray examination and treatment, or for or in connection with the sale, rental, supplying or furnishing of clinical laboratory services or supplies, x-ray laboratory services or supplies, inhalation therapy service or equipment, ambulance service, hospital or medical supplies, physiotherapy or other therapeutic service or equipment, artificial limbs, teeth or eyes, orthopedic or surgical appliances or supplies, optical appliances, supplies or equipment, devices for aid of hearing, drugs, medication or medical supplies or any other goods, services or supplies prescribed for medical diagnosis, care or treatment under this chapter, except payment, not to exceed thirty-three and one-third per centum of any fee received for x-ray examination, diagnosis or treatment, to any hospital furnishing facilities for such examination, diagnosis or treatment.

NC GS 90-401 A health care provider shall not financially compensate in any manner a person, firm, or corporation for recommending or securing the healthcare provider's employment by a patient, or as a reward for having made a recommendation resulting in the health care provider's employment by a patient.

317-A:17 Professional Misconduct. CHAPTER 317-A DENTISTS AND DENTISTRY (j) Knowingly or willfully violating any provision of this chapter, any substantive rule or order of the dental board, any federal, state, or local controlled drug law or other federal, state, or local laws or regulations pertaining to: (1) The practice of dentistry, and the Principles of Ethics and Code of Professional Conduct of the American Dental Association as reviewed and approved, in whole or in part, by the board; or ADA Code "4.E. REBATES AND SPLIT FEES. Dentists shall not accept or tender “rebates” or “split fees.” The prohibition against a dentist’s accepting or tendering rebates or split fees applies to business dealings between dentists and any third party, not just other dentists. Thus, a dentist who pays for advertising or marketing services by sharing a specified portion of the professional fees collected from prospective or actual patients with the vendor providing the advertising or marketing services is engaged in fee splitting.

19. Offering to effect or effecting a division of fees, or agreeing to split or divide a fee for dental services with any person, in exchange for the person bringing or referring a patient;

§ 5-31.1-10 Unprofessional conduct.The term "unprofessional conduct" as used in this chapter includes, but is not limited to, the following items or any combination of them and may be defined by regulations established by the board with the approval of the director:(12) Division of fees, or agreeing to split or divide the fees, received for professional services for any person for bringing to or referring a patient;

(Rule 0460-02-.10, continued) June, 2015 (Revised) 31 (4) Advertising Content. The following acts or omissions in the context of advertisement by any licensee shall constitute unethical and unprofessional conduct, and subject the licensee to disciplinary action pursuant to T.C.A. §63-5-124(a)(18).

(t) Directly or indirectly offering, giving, receiving, or agreeing to receive any fee or other consideration to or from a third party for the referral of a patient in connection with the performance of professional services.

RULE §108.58

Solicitation, Referrals and Gift Schemes

(a) This rule prohibits conduct which violates §§102.001 - 102.011 and §259.008(8), of the Texas Occupations Code. A licensee shall not offer, give, dispense, distribute or make available to any third party or aid or abet another so to do, any cash, gift, premium, chance, reward, ticket, item, or thing of value for securing or soliciting patients. A licensee may offer, give, dispense, distribute or make available directly to a potential patient, a non-cash gift valued at no more than ten dollars to secure or solicit the potential patient.

(b) This rule shall not be construed to prohibit a licensee from offering, giving, dispensing, distributing or making available to any patient of record any cash premium, chance, reward, ticket, item or thing of value for the continuation of that relationship as a patient of that licensee. The cash premium, chance, reward, ticket, item or thing of value cannot be for the purpose of soliciting new patients.

(c) This rule shall not be construed to prohibit remuneration for advertising, marketing, or other services that are provided for the purpose of securing or soliciting patients, provided the remuneration is set in advance, is consistent with the fair market value of the services, and is not based on the volume or value of any patient referrals.

58-69-502. Unprofessional conduct.

(1) "Unprofessional conduct" includes, in addition to the definition in Section 58-1-501:

(a) sharing professional fees with an unlicensed person or paying any person for sending or referring a patient;

UPDATE 11/08/2016 email from

I am an investigation supervisor with the Division of Occupational and Professional Licensing (DOPL). I have reviewed your complaint regarding White Pines Dental and the issue of fee splitting. Please be aware that your complaint is important to us and has been given every consideration. The Utah Dental Practice Act rule, Utah Code Annotated 58-69-502(1) reads in relevant part:

58-69-502 Unprofessional conduct.(1) "Unprofessional conduct" includes, in addition to the definition in Section 58-1-501:(a) sharing professional fees with an unlicensed person or paying any person for sending or referring a patient;.

This particular issue has been vetted thoroughly in the recent past with the Utah Attorney General Office. They have opined that the term"paying" refers to money only and not to gifts. To alter the AG's interpretation of the rule would require further clarification of the term "paying". There are many dental practices in Utah that are engaging in a similar business model as White Pines Dental, probably to include Megan Merica Snarr and Dr. Sorensen. That is why DOPL sought an interpretation of the rule from the AG's office. Until the Utah Dental Practice Act or Rule is further clarified to include things like gifts, parties or other things of value, DOPL will not be looking into the matter.

I did contact Dr. West and spoke to him about the business model of White Pines Dental. As their website indicates, they do offer to compensate patients for referrals to their office. However, there is not an exchange of money and therefore there is no violation of the Utah Dental Practice Act. If you have evidence to support that Dr. West, Dr. Megan Merica Snarr ,Dr. Sorensen or any other dental practitioner in the state of Utah are compensating their patients with money, please feel free to provide such to this office.

Thank you for taking the time to advise us of your concerns. Although an investigation will not be conducted at this time, your complaint will be kept in our files for future reference.