Register Today!
KCA Compliance Update: Referral Fees, Commissions, and a Familiar Problem
KCA continues to receive questions about referral fees, affiliate programs, and commission-based arrangements. While some of these programs may feel new, the underlying issue is not.
Many of you will remember a common model from years past involving TENS units. Companies would approach chiropractors and offer a commission for “selling” a unit to a patient. The company would then handle billing—often to insurance—and ship the product directly to the patient. While this was often framed as a convenience or patient benefit, regulators consistently focused on a different question:
Was the doctor being paid because of their professional influence over the patient?
That same question is showing up again today—just in new forms.
We are now seeing programs across multiple industries that offer compensation tied to patient purchases or participation. Recent examples include:
- Mattress referral programs that pay doctors a percentage when a patient buys a product
- Continuous glucose monitor (CGM) programs that offer providers commissions (in some cases around 10–15%) for enrolling patients
While these programs differ in product and structure, the core issue remains the same:
Compensation is triggered by a patient’s decision following a professional recommendation.
From a regulatory standpoint, this creates risk.
In Kansas, unprofessional conduct includes engaging in behavior that violates patient trust or exploits the doctor–patient relationship for personal gain. When a doctor receives compensation tied to a patient’s purchase—whether it’s a device, a product, or a service—regulators may view that arrangement through that lens.
Importantly, this analysis does not depend on:
- Whether the product is covered by insurance
- Whether the product is “medical” or retail
- Whether the commission is large or small
Instead, the focus is on the relationship, the influence, and the financial incentive.
What Hasn’t Changed
The structure may evolve—from TENS units, to affiliate links, to modern digital health platforms—but the compliance concern has remained remarkably consistent over time.
If a recommendation is made in the context of the doctor–patient relationship, and the doctor is paid because the patient acts on that recommendation, regulators may question whether that arrangement compromises professional judgment or patient trust.
Practical Takeaway
Before participating in any program that offers compensation tied to patient purchases or enrollment, ask:
- Am I being paid because my patient acted on my recommendation?
- Would this look like a commission for my professional influence?
- Could this be viewed as putting my financial interest alongside—or ahead of—the patient’s interest?
If the answer to any of those questions is “yes” or “maybe,” the arrangement deserves careful scrutiny.
KCA Guidance
KCA’s role is to help you identify risk before it becomes a problem. These arrangements are becoming more common—and more sophisticated—but the underlying compliance principles have not changed.
When in doubt:
- Be cautious with commission-based models tied to patient decisions
- Separate clinical recommendations from financial incentives
- Seek guidance when evaluating new programs
Protecting your license and maintaining patient trust must remain the priority.
If you have questions about a specific program, KCA is available to discuss general compliance considerations.
From a Colleague: Why Associations Matter
Dr. Glenn Jaffe, whom I’ve had the opportunity to work with through ChiroCongress, recently wrote a piece that does an excellent job outlining what a state chiropractic association is—and just as importantly, what it is not. Drawing on his experience as a past president of the North Carolina Chiropractic Association, Dr. Jaffe highlights the critical role associations play in advocacy, protecting scope, and advancing the profession, while also addressing some common misconceptions about their purpose. It’s a quick, worthwhile read that reinforces why strong state associations matter for every practicing chiropractor.
Updated Medicare ABN Now Available
The 2026 Updated Medicare ABN is now available here. (KCA Member Benefit – must be logged in to view).
You should immediately stop using the old ABN and start using this one for all Medicare patients.
Recent Comments