Fee Splitting - Fee Splitting in The USA

Fee Splitting in The USA

The situation in the USA is not entirely clear

According to the World Medical Association, "The AMA Code provides that payment by or to a physician solely for the referral of a patient is unethical as is the acceptance by a physician of payment of any kind, and in any form, from any source such as a pharmaceutical company or pharmacist or a manufacturer of medical appliances and devices, for referring a patient to that source. Another section specifies that clinics, laboratories, hospitals or other health care facilities which compensate physicians for referral of patients are engaged in fee-splitting, which is unethical".

Among its Definitions of Unprofessional Conduct, the "West Hudson Psychiatric Society Virtual Newsletter" (1997) lists Offering, giving or receiving a fee for the referral of a patient (fee splitting), or permitting any person other than an employee or associate to share in your fee, who has not provided an appropriate service directly under your supervision.

However, the practice, or something resembling it, tends to be tolerated - in "Medicine, Money, and Morals: Physicians' Conflicts of Interest" by Marc A. Rodwin, forms of fee splitting and commission paying for referrals remain common in the USA and are in effect tolerated by key overseeing bodies such as the American Medical Association and Joint Commission International, or JCI.

According to their website, the Joint Commission (JCI) have no published view on the issue of fee splitting, and in fact the Joint Commission stopped trying to provide guidance on medical ethics to American hospitals many years ago, preferring to concentrate on less challenging areas of healthcare assessment, despite the vast importance of medical ethics to patient safety. It is not clear if JCI operate to a similar level of standards when working outside of the USA.

The popular group marketing website groupon and other daily deal businesses have received the green light from some U.S. state bar associations, most notably North Carolina's State Bar formal opinion. However, approved in some jurisdictions, Alabama and other state bar associations have chosen to dissent from the NC state bar ruling, and have formally ruled in opposition to allowing daily deal websites as an ethical form of group marketing. Some state bar associations have yet to formally choose an opinion.