In today’s healthcare landscape, chiropractic offices must balance patient affordability with regulatory compliance. Many chiropractors want to offer discounts to help patients afford care, but discounting can lead to serious legal and financial consequences without proper legal structure. Understanding how to provide discounts legally ensures compliance with federal and state regulations while maintaining the integrity of a chiropractic practice.
Legal discounting refers to offering price reductions in a manner that complies with federal and state laws, including anti-kickback statutes, insurance regulations, and contract agreements. When done improperly, discounting can be viewed as insurance fraud, an inducement, a violation of provider agreements, and more.
Several key laws regulate how discounts should be applied in healthcare settings:
• The Anti-Kickback Statute (AKS): Prohibits financial incentives for referrals that could influence medical decisions.
• The False Claims Act (FCA): Prevents the submission of false claims for reimbursement, including misrepresenting fees.
• State Insurance Regulations: Often require consistency in billing and prohibit differential pricing based on insurance coverage.
Ignoring these laws can result in severe penalties, including fines, loss of licensure, and even criminal charges. (Little Health Law, 2025)
In an attempt to help their patients, many chiropractors unknowingly put their practices at risk by offering discounts incorrectly. Some common improper discounting practices include:
• Dual Fee Schedules: Charging more for insured patients than you do for uninsured patients violates provider agreements. Insurance companies expect chiropractors to bill consistently.
• Improper Time-of-Service Discounts: While time-ofservice (TOS) discounts can be legal, they must be based on actual cost savings to the practice rather than arbitrary price reductions. According to many consultants, the average cost savings in chiropractic offices is approximately 7%.
• Routine Waivers of Co-Pays and Deductibles: Many insurance contracts require that patients pay their portion of the bill. Routinely waiving these fees without proper documentation or contractual allowances can be seen as insurance fraud. The courts have held, if you don’t charge the patients for their deductibles and co-payments, it may relieve the insurance company from their obligation to pay.
• Inducement Violations: Federal and state laws prohibit offering discounts to induce patients to choose a specific treatment, provider, or service, which is prohibited under statutes like the Anti-Kickback Statute. (Stanger, 2024)
The good news is that chiropractors can legally offer discounts by following structured and compliant approaches. Here are some best practices:
Discount Medical Plan Organizations (DMPOs) provide a legally compliant way to offer discounts to patients. A DMPO is a third-party membership program that allows patients to access reduced fees in exchange for a membership fee. These plans are structured to comply with legal regulations, making them an excellent option for practices wanting to provide affordable care without violating laws.
"...chiropractors can legally offer discounts by following structured and compliant approaches.”
Time-of-Service (TOS) discounts are allowed when they reflect actual administrative savings. Because processing insurance claims comes with added costs (billing, collection, staff time), offering a discount to patients who pay at the time of service can be justified. However, the discount should be reasonable—typically 5 15%—and well-documented. (KMC University)
“Chiropractors should charge consistent fees to avoid issues with dual fee schedules.”
Offering discounts for financial hardship can be legal when structured correctly. A hardship discount program should include:
• A written policy outlining the criteria for qualification.
• A formal application process where patients demonstrate financial need.
Consistency in application to prevent accusations of discrimination or fraud.
Maintain Fee Schedule Consistency
Chiropractors should charge consistent fees to avoid issues with dual fee schedules. If discounts are offered, they should be applied through legally structured programs, not on a case-by-case basis. This ensures compliance and protects the practice from insurance fraud allegations. (Jensen, 2018)
Beyond compliance, legal discounting benefits both patients and chiropractic practices. Here’s how: (Perusich, 2024)
Expanding Patient Access to Care
Many patients struggle with affordability, especially those without insurance. Legal discount programs allow chiropractors to help patients while staying compliant. For example, Discount Medical Plan Organizations (DMPOs) offer patients a structured way to receive reduced fees compliantly.
Strengthening Patient Retention and Satisfaction
Patients who feel they have an affordable, transparent payment option are more likely to remain loyal to a practice. Legal discounting removes financial barriers, improving patient satisfaction and retention rates.
Enhancing Practice Revenue Stability
Legal discounting, when done correctly, helps create predictable revenue streams. Instead of relying on inconsistent collections or risking non-payment, structured discount programs ensure patients have a clear understanding of their financial responsibilities.
Avoiding Legal Consequences and Protecting Reputation
No chiropractor wants to face audits, fines, or legal troubles due to improper billing practices. Following compliant discounting methods, practices avoid potential lawsuits, insurance audits, and reputational damage.
Legal discounting in chiropractic is essential for maintaining compliance while making care accessible. Chiropractors must navigate complex regulations to avoid violating anti-kickback laws, insurance agreements, or state regulations.
By implementing compliant discount strategies such as DMPOs, structured time-of-service discounts, and hardship programs, chiropractors can offer patients ethical, legal, and beneficial pricing options. This approach protects the practice from legal risks and enhances patient satisfaction, retention, and overall financial stability.
Ultimately, the key to successful discounting is education and consistency. Chiropractors should regularly review their policies, consult legal or compliance experts, and stay informed about regulatory changes. By doing so, they can confidently provide discounted care without jeopardizing their practice’s future.
“If I Don’t Bill Insurance, I Can Charge Whatever I Want.”
Even if a chiropractor does not bill insurance, improper discounting can violate state regulations. Fee consistency is crucial; arbitrary pricing variations could lead to compliance risks.
“Cash Discounts Don’t Need Documentation.”
Time-of-Service discounts must be documented properly to justify the reduction. Failure to maintain documentation can raise red flags during audits. Documentation based on who is paying the bill is risky and may violate documentation requirements of your State Board of Examiners.
“I Can Offer Discounts to Certain Patients Without a Policy.”
Discounts must be applied consistently across all patients who meet specific criteria. Selective discounting may lead to accusations of discrimination or fraud.
Dr. Ray Foxworth is a certified medical compliance specialist and the president of ChiroHealth USA. A practicing chiropractor, he remains “in the trenches,” facing billing, coding, documentation, and compliance challenges. Foxworth has served as president of the Mississippi Chiropractic Association and is a former staff chiropractor at the G.V. Sonny Montgomery VA Medical Center. He is a fellow of the International College of Chiropractic. To request a free one-page financial policy, send an email to info@chirohealthusa.com.
