Since 2010, I’ve placed a strong emphasis on teaching jurisprudence and ethics at the National Academy of Osteopathy (Canada, USA) and the National University of Medical Sciences (Spain, USA, Panama). I’m proud to say that not a single one of my students has ever been found guilty of malpractice.
Just last week, I received a message from a manual osteopath who graduated from one of Canada’s oldest osteopathy schools—a four-year program that runs one weekend a month for six months each year in Ontario (Canada). One of my students had informed him that he could not charge clients two different fees: a higher fee for those with insurance coverage and a lower fee for those paying cash. This practice, known as two-tiered billing, is considered fraud and theft against insurers, and is a criminal act.
Shockingly, not only was he doing this, but he also advertised it openly on his website! When confronted, he checked with his professional association, which unbelievably told him that this was acceptable!
I was truly stunned that an osteopathy college would fail to teach basic jurisprudence and ethics, and that an osteopathy association could be so out of touch with the law.
This practitioner reached out to me on Facebook for clarification. I explained the law to him—he was shocked but grateful. He promptly updated his website and notified all his patients to correct his mistake.
Over the past 30 years, I have seen health professionals charged and taken to court for this very issue. Insurers treat two-tiered billing as theft. I saved him thousands of dollars in penalty, fines and legal cost, being blacklisted by insurers and a potential jail term if convicted of theft against insurers.
You can charge different fees, but only if the services are clearly different and the fee is the same for everyone, regardless of whether they have insurance. For example, toward the end of my chiropractic career 20 years ago, I charged $1,000 for specialized performance and injury-prevention care for elite professional athletes (I was the team doctor for F.C. Porto in Portugal and two other football teams)—services that differed from my standard care, for which I charged $275 per hour. The fee was the same whether the client had insurance or paid privately.
You can also legally offer discounts, but they must apply equally to everyone in that group. For instance, if you offer seniors a 20% discount, then all seniors must receive it, not just those who pay cash.
This dedication to protecting our students is one reason we have become the largest manual osteopathy school in the world. We constantly evolve our curriculum to ensure our graduates are protected. Remember: ignorance of the law is never a defense. I urge every osteopathy school to start teaching jurisprudence and ethics to prevent situations like this.
Dr. Shawn Pourgol, MBA, DC, DO, DN, PhD
Osteopath, Naprapath, Chiropractor & Founder of:
National Academy of Osteopathy (Canada, USA)
National University of Medical Sciences (USA, Spain, Panama)
Osteopathy Chronic Pain Clinics of Canada (380 clinics in 34 countries)
World Osteopathy Day