COMMONLY IGNORED ETHICAL RULES
Qualicare has been involved with a number of practitioners who seem not to understand, or have knowledge of certain of the Ethical Rules of the HPCSA.
We have highlighted certain recurring themes which have caused our members difficulty in the past 6 months, for your urgent attention and understanding.
A practitioner shall not permit himself or herself to be exploited in any manner especially when it comes to improper Financial Gain. “Improper financial gain or other valuable consideration” means money, or any other form of compensation, payment, reward or benefit which is not legally due or which is given on the understanding, whether express, implied or tacit, that the recipient will engage or refrain from engaging in certain behaviour in a manner which is either:
- Illegal; and/or
- Contrary to ethical or professional rules; and/or
- Which, in the opinion of the HPCSA, may adversely affect the interests of a patient or group of patients
RENTALS AND LOGISTICS FEES AS PERVERSE INCENTIVES
Healthcare practitioners shall not:
- Pay rentals in lease agreements between healthcare practitioners and health establishments that are not market related or are at preferential rates.
- Enter into lease agreements with health establishments or services that wish to rent consulting rooms to medical professionals at rates conditional on the healthcare practitioner achieving a certain turnover or targets such as admission of a specific number of patients at a private healthcare facility.
- Rent consulting rooms from health establishments or services under financial arrangements that are not openly available to other similarly qualified healthcare practitioners.
- Accepting commission
Healthcare practitioners shall not accept commission or any financial gain or other valuable consideration from any person or body or service in return for the purchase, sale or supply of any goods, substances or materials used by the healthcare professional in his or her practice.
- Paying commission
Healthcare practitioners shall not pay commission or render any financial gain or other valuable consideration to any person for recommending patients.
CHARGING OR RECEIVING FEES:
- For referring patients
Healthcare practitioners shall not charge a fee or receive any financial gain or other valuable consideration for referring patients to the other health professionals or for participation in drug trials or other research trials of a similar nature.
- For seeing representatives
Healthcare practitioners shall not charge a fee or receive any financial gain or other valuable consideration for seeing medical representatives.
- Charging a consultation fee for an appointment that was not kept.
A practitioner shall not charge or receive fees for services not rendered. An appointment that was not honoured by the patient is equivalent to services not rendered, and for that, a practitioner may not charge or receive fees.
Healthcare practitioners shall not enter into a contract to work in a particular health establishment or service on the understanding that the health care professional generates a particular amount of revenue for such health establishment or service.
A health establishment or service that equips a theatre, ward or other facility for a specific healthcare practitioner according to his or her specifications may enter into a contractual agreement with such healthcare professional on condition that such health establishment or service may not stipulate any turnover targets for the healthcare practitioner concerned.
Healthcare practitioners shall not provide a service or perform or direct certain procedures to be performed on a patient that are neither indicated nor scientific or have been shown to be ineffective, harmful or inappropriate through evidence-based review.
SHARING OF FEES:
A practitioner shall not share fees with any person or with another practitioner who has not taken a commensurate part in the services for which such fees are charged, however a practitioner my charge or receive fees for services not personally rendered, if those services were rendered by another practitioner in his or her employment or with whom he or she is associated as a partner, shareholder or locum tenens and who is registered in terms of the Health Professions Act (Act No. 56 of 1974).
Corporate entities typically provide certain management services and infrastructure to providers in return for financial reward, which often amounts to a percentage of turnovers.
Should providers receive a percentage of fees billed in return for these services, such arrangements are regarded as transgressing the ethical rule prohibiting the sharing of fees between a practitioner and a person who did not render a commensurate part of the services (dichotomy). Charges levied for these services should be on a previously agreed rate and not based on a percentage of the income of the practitioner. That agreed rate may not be based on commission or income.
Similarly, paying a percentage of your debtors’ book to debt collectors for the collection of professional fees transgresses the ethical rule prohibiting the sharing of fees between a practitioner and a person who did not render a commensurate part of the services.
ALLOWING A BUSINESS PERSON OR ANOTHER DOCTOR TO USE YOUR BHF PRACTICE NUMBER
Recently it has come to our attention that business persons are setting up and equipping medical practices in return for managing the doctor’s outgoing accounts. They use the doctors practice number to dupe the medical aids into thinking that the doctor is personally performing medical or surgical services. The unsuspecting doctor’s practice number and accounts are then used for a number of other unrelated practices, and the corporate siphons off the majority of the income and pays the doctor a salary as well as an incentive for the use of his practice number.
This is not only unethical in terms of the Fee Sharing rules of the HPCSA, but could also land the doctor in difficulty with VAT, and SARS.
Tony Behrman and the Qualicare Team