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Dermatoethics pp 177-184 | Cite as

Defining the Gray Zone: Client Billing and Contractual Joint Ventures

  • Homer O. WilandIV
  • Barry D. Kels
  • Jane Grant-Kels
Chapter

Abstract

Client billing is a practice in which the referring clinician pays the dermatopathology laboratory a fixed amount for both the technical and professional fees to prepare and interpret the biopsy, and then the clinician bills the Please provide affiliation details for all authors.patient or insurer. Although not inherently illegal or unethical, the practice becomes ethically suspect when a clinician takes advantage of client billing to secure personal profit, or fails to act in the patient’s best interest by not selecting the highest quality laboratory to interpret the patient’s biopsies. Contractual joint ventures are practice models which allow groups of clinicians to bill for work done by independently contracted (‘pod” model) or employed pathologists (“vertically integrated” model), practices that otherwise would not be permitted under Medicare reassignment rules. This chapter presents ethical arguments for and against these practices using illustrative case scenarios.

Dermatopathology faces many ethical issues, but one of the most contentious is “client billing.” Proponents argue that it meets the pathology needs of clinical dermatologists in an efficient and cost-effective manner. Skeptics counter that it is a blatant, unethical attempt to induce referrals through a system of thinly veiled “kickbacks.” Due to the millions of dollars involved and ethical implications, this is a critical issue to dermatopathologists, clinical dermatologists, patients, and third-party payers. In this chapter, sample scenarios highlight the ethical, legal, and financial issues related to billing for laboratory services and utilization, including evolving methods of contractual joint venture. The ethical obligations of clinical dermatologists and dermatopathologists will be discussed based on accepted tenets of professionalism and the American Medical Association (AMA) Code of Ethics.

Keywords

Laboratory Service Medicaid Patient Clinical Dermatologist Technical Component Safe Harbor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  • Homer O. WilandIV
    • 1
  • Barry D. Kels
    • 2
  • Jane Grant-Kels
    • 3
  1. 1.Department of PathologyCleveland Clinic FoundationClevelandUSA
  2. 2.Division of Ophthalmology, Department of SurgeryUniversity of Connecticut Health CenterFarmingtonUSA
  3. 3.Department of DermatologyUniversity of Connecticut Health CenterFarmingtonUSA

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