MASSACHUSETTS - BILLING ISSUES

January 1, 2008

Massachusetts state laws and regulations that affect your medical practice

1. Does Massachusetts have specific restrictions on physician billing?

No. There are no regulations limiting what a physician may charge for a particular service, although physicians may not bill Medicare recipients for more than the charge established by the U.S. Secretary of Health and Human Services. Still, most consumer protection laws do apply, and it would be illegal for a physician to charge for services not provided or for services that were actually unnecessary.

Massachusetts Attorney General Website: "Health Care"

Yes. While the consumer protection laws do not apply to negligent provision of health care or malpractice, they do apply to the business and entrepreneurial aspects of a medical practice. Fraudulent and deceptive billing practices are therefore actionable under consumer protection laws.

Darviris v. Petros, 442 Mass. 274, 279-280 (2004).

3. May a physician charge cancellation fees for canceled appointments?

Yes. Physicians may charge a cancellation fee, or the entire fee for the service in question, as long as such fees are clearly disclosed to the patient prior to service.

Massachusetts Attorney General Website: "Health Care"

4. May a physician charge interest on unpaid bills?

Yes. Medical services follow the same rules as any other ordinary consumer transactions. A physician is entitled to charge interest on unpaid bills.

Massachusetts Attorney General Website: "Health Care"

5. What are the restrictions, if any, on refusing treatment to a patient with an outstanding bill?

If a patient does have a legitimate outstanding bill with any business in Massachusetts, the business, even a health care provider, may refuse to continue to do business with that patient unless an agreement can be entered into regarding payment of the amounts due. However, a health care provider may not refuse to treat a patient if he or she is in the midst of a medical crisis situation for which the lack of immediate treatment would endanger the patient's health.

Massachusetts Attorney General Website: "Health Care"

6. Are there any specific guidelines regarding treating people involved in automobile accidents?

Yes. Any physician who knowingly and willfully provides excessive treatment or issues excessive bills to a patient that is intended to permit the patient to incur medical expenses in excess of the tort threshold shall, upon a finding of such by the Board, have his physician's license suspended for a period of not less than one year, unless the Board finds unusual and extenuating circumstances which would warrant a lesser sanction.

243 MA ADC 2.07

7. What constitutes "excessive treatment?"

Excessive treatment shall include treatment that exceeds the medical needs of the patient, or is unrelated to the diagnosis of an injury, or reasonably suspected possible injury, incurred in connection with the motor vehicle accident, or is designed to enable the patient to incur medical expenses in excess of the tort threshold.

243 MA ADC 2.07

8. What constitutes "excessive bills"?

Excessive bills shall include bills for services and activities that were not performed or bills that overstate the amount of time spent treating the patient. Such excessive treatment, or excessive bills, shall constitute conduct which places in question the physician's competence to practice medicine.

243 MA ADC 2.07

Copyright Kern Augustine Conroy and Schoppmann, P.C. Used with permission.