NMC orders crackdown on Referral fee, Commissions, and online procurement of patients

New Delhi: With the recent release of its draft of The National Medical Commission (NMC) Professional Conduct Guidelines, the apex medical regulator has sought to issue a crackdown on the rampant practice of unethical referrals to other medical practitioners as well as diagnostic laboratories in exchange for a sum or a percentage of their fee also known as a "referral" or a "cut"

While the previous Medical Council of India ( MCI) Code of Ethics also categorized the practice of referrals as "unethical" , the NMC in its draft has linked this unethical pracitce to a quantum of punishment that can range from a 1-month suspension to a 3-month suspension. 

Further, Keeping in mind the growing trends and the new advancements in technology, the commission has also noted specially about the internet of referrals stating that "RMP shall not use online forums or agents for procuring patients." This is also been taken care of in the Social Media guidelines issued by the NMC that can be accessed on the link below. 

The commission or the "cut" practice has known to be rampant in the medical field. Certain Diagnostic firms engaging in the practice have known to give as high as 50% of the MRP of the test as referral fee. Even Super-speciality hospitals have been accused of engaging in the cut practice, with marketing departments working with local doctors and smaller hospitals to divert patients for "high paying" super-speciality procedures at their hospitals. In the past few years, with the internet explosion, there have also been rise in "listing websites", where doctors are listed and which divert patients to the their listed doctors in return of a fixed charge or percentage of fee. Many of these websites have also been angrily termed as "online touts" by members of the medical profession. 

The NMC, with its new guidelines aims to put a full stop to all these unethical practices putting the onus on medical practitioners not to engage in these practices, otherwise, action may follow. 

Sections of the draft National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2022 prohibit the practice of fee spliiting and Commissions

"Prohibition of Fee Splitting/Commissions: A RMP shall not directly or indirectly participate in any act of division, transfer, assignment, subordination, rebating, splitting, or refunding of any fee for diagnostic, scanning, medical, surgical, or other treatment. These provisions shall apply with equal force to the referring, recommending, or procuring by a RMP of any patient, specimen, or material for diagnostic purposes or other studies/work. However, nothing in this section shall prohibit payment of salaries by a qualified RMP to another duly qualified person rendering medical care under his/her supervision. RMP shall not use online forums or agents for procuring patients. (L3)"

Referral: Only such Follow up consultation should be planned as required by the patient. Likewise, laboratory investigations ordered for the patient should be justified. An update/summary of the clinical condition and reasons for referral must be documented and provided at the referral. Specialist referral must be sought to benefit only the patient and duly justified in medical documents (L2)

Violations of these have been categorised as L2, and L3 penalty. A Level 2 is defined as one that  may be awarded even when the role of the doctor in causing direct harm was not conclusively proved but the doctor was found to have breached any of the codes listed above. The maximum action is a suspension of the license to practice for up to one month (30days).

A level 3 penalty on the other hand is one that may be awarded when the role of the doctor in causing direct harm was conclusively proved and the doctor was found to have breached relevant regulation. This maximum action is a suspension of the license to practice for a maximum period of three months. Holding suspension can be given in this level as per regulations