A free haircut with every injection?
Editor's note: "The Higher Ground" columnist, Joe Gryskiewicz, MD, is a former member of the ASPS Judicial Council and has been in practice for more than 25 years. Readers are encouraged to submit queries directly to him at firstname.lastname@example.org. Names will be withheld, and the views expressed in this column are those of the author.
Q: A hair salon in my area is offering customers a free haircut/color if they get Botox® with a local plastic surgeon. The kicker is that the coupon is handed out by the hair salon. Obviously, money must change hands. Is this an anti-kickback violation?
A: You can't be certain that money is exchanging hands – maybe a "trade" of some sort is transpiring. Either way, it is cosmetic medicine between a physician and non-physician, so it is not subject to Medicare/Medicaid, nor does it fall under the anti-kickback statutes. This doesn't even fall under the ASPS Code of Ethics' contest or raffle guidelines since no "incision" is being made. That being said, the ASPS Code of Ethics and many states prohibit giving away anything of value directly in exchange for referrals. If the surgeon in your example isn't raising his/her price for the Botox, but rather just sending a portion of it to the salon, then there may technically be a violation, but it's unlikely anyone would care.
What if the patient would be eligible to receive a free botulinum toxin injection if the patient had purchased a haircut/color in a salon or comprehensive medical spa as a first step? It might not be a good business plan - though a good haircut can be pretty expensive - but would you still question the ethics of the offer?
I guess if this happened to me, I would begin asking questions about why? And what are they both getting out of this? If there was a medical spa that did haircut/color as part of a plastic surgeon's office, then it would make sense to me, but it just doesn't seem like a good marriage. More objectively, we can always discount or give away injectables, so this arrangement seems to pass the "sniff test," and I don't see an ethical problem with this practice.