Ethics

Fees for Medical Services

Code of Medical Ethics Opinion 11.3.1

Physicians are expected to conduct themselves as honest, responsible professionals. They should be knowledgeable about and conform to relevant laws and should adhere to professional ethical standards and sound business practice. Physicians should not recommend, provide, or charge for unnecessary medical services. Nor should they make intentional misrepresentations to increase the level of payment they receive or to secure noncovered health benefits for their patients.

With regard to fees for medical services, physicians should:

(a) Charge reasonable fees based on the:

  1. Kind of service(s)
  2. Difficulty or uniqueness of the service(s) performed
  3. Time required to perform the service(s)
  4. Skill required to perform the service(s)
  5. Experience of the physician
  6. Quality of the physician's performance

(b) Charge only for the service(s) that are personally rendered or for services performed under the physician’s direct personal observation, direction, or supervision. If possible, when services are provided by more than one physician, each physician should submit his or her own bill to the patient and be compensated separately. When physicians have professional colleagues assist in the performance of a service, the physician may pay a reasonable amount for such assistance and recoup that amount through fees charged to the patient, provided the patient is notified in advance of the financial arrangement.

(c) Itemize separately charges for diagnostic, laboratory, or clinical services provided by other health care professionals and indicate who provided the service when fees for others’ services cannot be billed directly to the patient, in addition to charges for the physician’s own professional services.

(d) Not charge excessive fees, contingent fees, or fees solely to facilitate hospital admission. Physicians must not charge a markup or commission, or profit on services rendered by other health care professionals.

(e) Extend professional courtesy at their discretion, recognizing that it is not an ethical requirement and is prohibited in many jurisdictions.

AMA Principles of Medical Ethics: II, VI

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Code of Medical Ethics: Financing and delivery of health care

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