The Federal government, and several of the states, have specific laws governing financial transactions between medical care providers. These laws include the Medicare Fraud and Abuse laws and the Stark I and Stark II, which apply to care paid for in whole or in part by the Federal government.

These laws can prohibit otherwise permissible discounts or “no charges.” For example, a surgeon who only gave professional courtesy to physicians who referred her business would clearly violate the law. Professional courtesy based on being on the same hospital staff would raise the same issues, although the link to referrals is more tenuous. Giving professional courtesy to all physicians without conditions would be more defensible, but if the government could show that a disproportionate number of physicians receiving the courtesy were also referring physicians, the court would probably rule that this was a prohibited inducement.