Per-Patient Payments to a Gym and a Free Exam Coupon
Dr. Reed opens a practice beside a fitness center. The gym advertises a free eye examination by Dr. Reed for any member who books through the gym. Dr. Reed pays the gym $25 for each member who completes an examination. At check-in, patients are told a $45 technology fee applies to the free examination. Dr. Reed also sells a $39 coupon on a deal site that advertises an eye examination plus a free contact lens fitting; the fine print says the fitting is an additional $60 and that contact lens purchase is required. Dr. Reed’s spouse owns the optical dispensary next door and pays rent that is below the market rate for the space.
1. Evaluate the $25 per-patient payment to the gym. What business-practice rule is implicated?
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Paying the gym $25 for each member who completes an examination is a per-referral payment. It creates a financial incentive to steer patients based on the payment rather than the patient’s needs, and it is the kind of fee-splitting or referral-compensation arrangement that optometry business-practice rules prohibit. The label does not matter: it could be called marketing, a finder’s fee, or a promotional payment. The Board is concerned with the substance of the arrangement. A permitted arrangement would be a fair-market-value lease or advertising fee that is not tied to patient volume. Dr. Reed should stop the per-patient payments, review the written agreement, and correct any past payments or disclosures as the Board requires.
2. Is the free examination advertisement and the $45 technology fee deceptive? How should the offer be structured?
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The advertisement is deceptive if the examination is not actually free. Telling patients at check-in that a mandatory $45 technology fee applies contradicts the free offer and can mislead the public. A permissible advertisement must disclose the true total cost or clearly identify what is included and what is not. A technology fee that every patient must pay is part of the price, not an optional extra. Dr. Reed should either waive the fee for the advertised free examination or advertise the actual charge. The office should also keep copies of advertisements and scripts, train staff to quote the same terms, and honor the offer as advertised. Deceptive advertising can support discipline even if no patient complains.
3. What about the coupon’s fine print and the below-market lease with the spouse’s dispensary?
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The coupon must disclose all mandatory charges and conditions in the advertisement, not only in fine print that patients see after purchase. If a contact lens fitting is professionally necessary for the examination, bundling it as a paid extra can be misleading; if lens purchase is required to receive the advertised fitting, that condition must be clear. The below-market lease with the spouse’s dispensary raises a separate fee-splitting concern: below-market rent can be an indirect way of sharing optical revenue. The arrangement should be documented in a written lease at fair market value, with arm’s-length terms and no tie to referrals. Dr. Reed should not accept rent concessions in exchange for patient flow. Both the coupon and the lease should be reviewed for truthfulness and improper inducement.