Defining the Gray Zone: Client Billing and Contractual Joint Ventures

Abstract

Client billing is a practice in which the referring clinician pays the dermatopathology laboratory a fixed amount for both the technical and professional fees to prepare and interpret the biopsy, and then the clinician bills the Please provide affiliation details for all authors.patient or insurer. Although not inherently illegal or unethical, the practice becomes ethically suspect when a clinician takes advantage of client billing to secure personal profit, or fails to act in the patient’s best interest by not selecting the highest quality laboratory to interpret the patient’s biopsies. Contractual joint ventures are practice models which allow groups of clinicians to bill for work done by independently contracted (‘pod” model) or employed pathologists (“vertically integrated” model), practices that otherwise would not be permitted under Medicare reassignment rules. This chapter presents ethical arguments for and against these practices using illustrative case scenarios.