Fee Splitting/Kickbacks

Fee-splitting is a common practice in Emergency Medicine in which the contract management company takes a portion of the physician-generated fees for management expenses and overhead. In some cases, the percentage of fees taken can be excessive and far beyond the fair market value for the services rendered by the contract management company. In other cases, the fees taken can be considered a kickback because the contract management company is essentially referring the patient to the emergency physician.

Leaders in medicine such as the American Medical Association and Dr. Arnold Relman, editor emeritus of The New England Journal of Medicine, have taken strong ethical stands against fee-splitting.

• Ethical Aspects of Fee-Splitting
• Arnold Relman Quote

There are also a number of very specific regulations and ruling which control when and in what circumstances fee-splitting is and is not appropriate.

• The Federal Fee-Splitting Kickback Statute
• OIG Rules that Hospitals Cannot Take Physician Fees
• Fee-Splitting by Hospitals
• Inspector General Comments on PPMs Taking a Percentage of Revenues
• Specifics of Employment "Safe Harbor" for Fee-Splitting

AAEM encourages is members to make themselves aware of this issue on the impact it has on the care of their patients and their professional welfare. Violations of fee-splitting regulations can be reported and acted upon in the following ways.

• Requesting an OIG Advisory Opinion
• Reporting or Inquiring about Fee-Splitting

Other headlines in this area include:

• Percentage Take by PPM Illegal in FL (added 11/10/03)
• Successful Fee-Splitting Suit by Radiologists