Listing a practice on booking marketplaces

A marketplace offers to list your practice next to others in your area, show your cash prices, and let patients book a slot without calling. The sales pitch is about new patients. The contract is about money: a monthly fee, a fee for each booking, or a share of what the patient pays. Before you sign, four questions deserve an answer. Is the fee structure a problem under federal or state referral fee laws? Who is responsible for the price the patient sees? Do your Good Faith Estimate duties still apply when a patient books on someone else’s site? And what patient information goes to the marketplace, and on what basis?

This guide sits next to related ones. How to state a cash price is in our guide to advertising cash prices, the estimate rules are in Good Faith Estimates for self-pay patients, pay-per-lead offers are in buying patient leads, free and paid listings are in directory listings for medical practices, and booking tools on your own site are in online booking widgets. This one is about listing on a third-party marketplace that shows prices or books appointments for you. For voucher sites that keep a share of each sale, see our guide to daily deal sites and fee-splitting rules.

This is general information, not legal advice. Sources cited were checked on October 31, 2026: 42 USC 1320a-7b(b); 42 CFR 1001.952(f); OIG Advisory Opinions 08-19 (issued October 29, 2008) and 19-04 (issued September 5, 2019); Cal. Bus. and Prof. Code 650; Fla. Stat. 456.054 and 458.331(1)(i); N.Y. Educ. Law 6530(18) and (19); 15 USC 45; 16 CFR 464.1 and 464.2; 45 CFR 149.610 and 149.620; 45 CFR 160.103 and 164.502; the HHS Office for Civil Rights Health App Use Scenarios (February 2016); and 16 CFR 465.2, 465.4, 465.5 and 465.7. Apart from OIG advisory opinions, which bind only the parties who asked for them, we found no federal rule or agency guidance written for price comparison or booking marketplaces as such. State law differs, so have a health care attorney in your state review a marketplace contract before you sign it.

The short version

A fee for each booking or each click can implicate the federal Anti-Kickback Statute when the booked services are payable by a Federal health care program (42 USC 1320a-7b(b)(2)). OIG has said per patient and similar variable fees are particularly problematic because they relate to the volume or value of business.
In Advisory Opinion 19-04, OIG found a low risk in one booking marketplace’s per-booking and per-click fees, for reasons tied to its facts: fees set in advance at fair market value, the same fee whatever the patient’s insurance, and paid fees that did not buy better placement in the results.
State laws reach all payers. California, Florida and New York each have referral fee or fee-splitting provisions, and New York’s covers percentage arrangements for space, facilities, equipment or personnel services.
The price on the marketplace is your advertising. Section 5 of the FTC Act bars deceptive practices (15 USC 45(a)(1)). The FTC’s fee disclosure rule covers only live-event tickets and short-term lodging (16 CFR 464.1), so no federal rule we found sets a format for medical price listings.
Good Faith Estimate duties sit with the convening provider, not the marketplace (45 CFR 149.610). A booking on a marketplace is still a scheduled service.
Whether the marketplace is your business associate depends on whether it handles patient information on your behalf (45 CFR 160.103). Ask, and put the answer in writing.
Reviews posted on the marketplace fall under the FTC consumer review rule: no fake reviews, no reviews bought for a particular sentiment, and no undisclosed reviews by owners or managers (16 CFR 465.2, 465.4, 465.5).

Per-booking and percentage fees under the Anti-Kickback Statute

The Anti-Kickback Statute makes it a felony to knowingly and willfully offer or pay any remuneration to induce a person to refer an individual for, or to arrange for or recommend, any item or service payable in whole or in part by a Federal health care program, such as Medicare or Medicaid (42 USC 1320a-7b(b)(2)). In Advisory Opinion 19-04, OIG said a booking marketplace’s scheduling services arrange for the furnishing of services, and a practice that pays it is the payer the statute names. Intent decides the case, so the same fee can be lawful in one setup and a problem in another.

In Advisory Opinion 08-19, about a pay-per-call service for chiropractors, OIG wrote that per patient, per unit of service and similar variable compensation structures are particularly problematic under the statute, because they relate to the volume or value of business potentially generated between the parties. A fee for each new patient booking is that kind of structure. So is a percentage of what the patient pays.

The regulations include a referral services safe harbor at 42 CFR 1001.952(f). Its conditions are strict. The service may not exclude any qualified participant, each participant’s payment must be assessed equally and based only on the cost of operating the service, not on the volume or value of referrals, and the service must make five written disclosures to each person seeking a referral, including whether the participant paid a fee. A per-booking fee or a percentage of the visit price is not a cost-based fee assessed equally, so a marketplace using one is unlikely to fit this safe harbor. That does not make the arrangement unlawful; it means the facts carry the weight.

If no service booked through the marketplace is payable by a Federal health care program, this statute may not reach the arrangement. That is a narrower carve-out than it sounds. A practice that sees Medicare patients for certain services and lists only cash services on the marketplace should confirm that Medicare or Medicaid patients cannot book through the listing, and that the listed services are not ones those programs pay for. The state laws below apply whoever pays.

What OIG said about a booking marketplace in Advisory Opinion 19-04

Advisory Opinion 19-04, issued September 5, 2019, reviewed an online directory where users searched for and booked appointments, and where providers paid annual fees plus a fee for each new-patient booking or each click, and could buy sponsored ads. OIG concluded that the arrangement could generate prohibited remuneration if the intent were present, but that it presented a low risk of fraud and abuse and that OIG would not impose sanctions. It reached that result for the combination of these facts:

The booking and click fees were set in advance, and the requestor certified that the aggregate listing fees did not exceed fair market value.
The fees did not depend on the user’s insurance status, and the per-booking fee applied only to new patients and, apart from a 24-hour window, whether or not the appointment was later cancelled.
A provider’s place in the search results depended only on the user’s own search criteria and similar user-centric information. Paying more did not buy more appearances or better placement.
The company was not a provider or supplier, was not affiliated with a listed provider, and did not recommend a particular provider.
Its advertising was passive: beneficiaries saw it only if they visited the site or a site showing the ads. Sponsored results were clearly labeled as paid, and the site told users that providers pay to be listed.
The ads promoted providers, not particular items or services, and beneficiaries received nothing of value beyond the use of the site itself.

An advisory opinion is limited to the facts the requestor certified and can be relied on only by that requestor. It is still the clearest statement we found of what OIG weighs when a provider pays a booking marketplace. Use the list above as questions for the marketplace you are considering. Our guide to buying patient leads covers Advisory Opinion 08-19 in more detail.

State fee-splitting and referral fee laws

State laws reach cash-pay and commercially insured patients too. Three examples show how differently they are written. Read your own state’s text with counsel.

California. Business and Professions Code 650(a) makes it unlawful for a licensee to offer, pay or accept any consideration as compensation or inducement for referring patients. Section 650(b) adds that paying for services other than the referral of patients based on a percentage of gross revenue or a similar arrangement is not unlawful if the payment is commensurate with the value of the services furnished. The question for a marketplace fee is whether it pays for referrals or for a service, such as advertising or scheduling software, at a price that matches its value.

Florida. Florida Statutes 456.054(2) makes it unlawful for a health care provider to offer, pay, solicit or receive a kickback for referring or soliciting patients, and 456.054(1) defines a kickback as a payment to induce referrals when the payment is not tax deductible as an ordinary and necessary expense. For physicians, 458.331(1)(i) lists paying any commission, bonus, kickback or rebate, or engaging in any split-fee arrangement, for patients referred, as grounds for discipline.

New York. Education Law 6530(18) defines as professional misconduct offering or giving any fee or other consideration to a third party for the referral of a patient. Section 6530(19) bars permitting any person to share in the fees for professional services, apart from listed exceptions such as partners and employees, and it includes arrangements where the payment for space, facilities, equipment or personnel services is a percentage of, or otherwise depends on, the licensee’s income from the practice. A marketplace that takes a percentage of the fee for a physician’s professional service raises a question under this section. Ask New York counsel before agreeing to one.

Dental, chiropractic and other boards have their own rules. A marketplace that serves more than one profession may use one contract for all of them, so check the rules for your license, not the marketplace’s summary of them.

Prices on the listing

The price a patient sees on the marketplace is your advertising, whoever typed it in. Section 5 of the FTC Act declares unfair or deceptive acts or practices in commerce unlawful (15 USC 45(a)(1)). The FTC’s rule on hidden fees, 16 CFR 464.2, requires the total price up front, but its definition of a covered good or service in 464.1 is limited to live-event tickets and short-term lodging. We found no federal rule that sets a format for price listings by medical practices.

No federal rule requires that a marketplace price match the price on your own website. We recommend that it does, or that the listing says why it differs. We also recommend that the listing says what the price includes and what it does not, such as the visit but not lab work, that any booking fee the marketplace charges the patient is shown before booking, and that someone at the practice checks the listing whenever your prices change. Our guide to advertising cash prices covers starting-at prices, packages and discounts.

Good Faith Estimates still come from you

The No Surprises Act rules at 45 CFR 149.610 put the Good Faith Estimate duty on the convening provider or facility, defined as the one that receives the request and is responsible for scheduling the primary item or service. A marketplace that takes the booking does not become the convening provider under that definition, and the rule does not shift the duty to it.

The convening provider must ask whether the patient is uninsured or self-pay, or insured but not seeking to have a claim submitted (149.610(b)(1)(i), (ii)). It must tell those patients that an estimate is available, in writing on its website, in the office and on-site where scheduling happens, and orally when scheduling or when cost questions come up (149.610(b)(1)(iii)). Any discussion of potential costs counts as a request (149.610(b)(1)(iv)). The estimate is due no later than 1 business day after scheduling when the service is scheduled at least 3 business days ahead, no later than 3 business days after scheduling when it is scheduled at least 10 business days ahead, and no later than 3 business days after a request (149.610(b)(1)(vi)).

A price on a marketplace is not a Good Faith Estimate. The rule lists the contents an estimate must include, among them the patient’s name and date of birth, an itemized list of expected items and services with codes and expected charges, and each provider’s National Provider Identifier and Tax Identification Number (149.610(c)(1)). If the final bill comes in at least 400 dollars above the expected charges on the estimate, the patient can use the federal dispute process (45 CFR 149.620). So set up the marketplace booking to land in the same intake step as a phone booking, where your staff asks the self-pay question and sends the estimate on time. Our Good Faith Estimate guide walks through the steps.

Is the marketplace your business associate?

Under 45 CFR 160.103, a business associate is a person who, on behalf of a covered entity, creates, receives, maintains or transmits protected health information for a regulated function or activity, or who provides listed services, such as management or administrative services, to the covered entity that involve disclosing protected health information. The deciding words are on behalf of.

The HHS Office for Civil Rights addressed the same question for app developers in its Health App Use Scenarios (February 2016). A developer is a business associate when it creates or offers the app on behalf of a covered entity. It is not one when a consumer uses the app to manage their own information without the involvement of their providers. A booking marketplace can sit on either side. One that patients find on their own and use to request an appointment may be acting for the patient. One you hire to run your scheduling, that holds your calendar and patient records, or that you embed on your website may be acting for you.

Your own duty is clearer. Information that flows from your practice to the marketplace, such as appointment confirmations, whether the patient arrived, or visit details used to bill a per-booking fee, is a use or disclosure by a covered entity, and 45 CFR 164.502(a) permits it only as the Privacy Rule allows. If the marketplace is your business associate, you need a business associate agreement first. If it is not, ask counsel which permission, if any, covers what you would send. Our guides to business associate agreements with marketing vendors and booking widgets go further.

Reviews on the marketplace

Booking marketplaces display reviews, and the FTC rule on consumer reviews and testimonials applies to what a business does with them. Under 16 CFR 465.2(a), a business may not write or create a review that misrepresents that the reviewer exists, used the service, or had the experience described. Under 465.2(c), it may not get such reviews from its officers, managers, employees or agents, or their immediate relatives, for posting on a third-party platform. Under 465.4, it may not offer compensation or other incentives conditioned on a review expressing a particular sentiment. Under 465.5(a), an officer or manager may not review the business without clearly disclosing the relationship.

Under 465.7(a), no one may use an unfounded or groundless legal threat, intimidation, or a public false accusation made knowing it was false or with reckless disregard, to stop a review from being written or to get it removed. If a review is false, use the marketplace’s own process. Reply without confirming that the reviewer is a patient; our guide to replying to negative reviews under HIPAA explains why.

Questions to ask a marketplace before you sign

How is the fee set: flat, per booking, per click, or a percentage of the patient’s payment? Is it set in advance, and how was the amount chosen?
Does the fee or placement change with the patient’s insurance, or with the services the patient ends up receiving?
Does paying more, or a higher tier, change where we appear in organic results? How are paid placements labeled?
Can Medicare or Medicaid patients book us through the listing? Can that be switched off for listed services?
Does the site tell patients that providers pay to be listed?
Who can edit our prices and descriptions, and will we see a change before it goes live?
Does the marketplace charge the patient a booking fee, and where is it shown?
What patient information does it collect, what does it send us, and what does it expect back from us?
Does it consider itself our business associate? Will it sign a business associate agreement, and what would that agreement cover?
How does it handle reviews, review removal requests and replies?

Use and avoid

Use: “Office visit, [price]. Lab tests, if ordered, are billed separately. Ask us for a Good Faith Estimate.”
Avoid: A starting price on the marketplace that you do not offer in the office.
Use: A flat listing fee or a fee set in advance, reviewed by counsel against federal and state law.
Avoid: A percentage of each patient’s payment, agreed without checking your state’s fee-splitting rule.
Use: “After you book, our office will contact you to confirm and send a Good Faith Estimate if you are paying yourself.”
Avoid: Treating the marketplace price as the estimate.
Use: A general request to booked patients to share their experience, good or bad.
Avoid: A discount for patients who leave a five-star review.

An illustration

This example is invented. [Practice name] is a self-pay practice that offers a set of office procedures. A marketplace offers a listing with no monthly fee and a percentage of each patient’s payment, plus a paid tier that moves the practice to the top of local results.

The office manager starts with the contract. Counsel reads the percentage fee against the state’s fee-splitting law and asks for a flat fee instead; the marketplace offers a fixed fee per booking set in advance, which counsel accepts after checking that Medicare and Medicaid patients cannot book these services through the listing. The practice declines the paid tier because the site does not label it as paid.

Then the listing. The prices are copied from the practice’s own price page, with the same notes on what is included. Bookings arrive in the scheduling inbox, where staff ask the self-pay question and send estimates on the same timeline as phone bookings. The marketplace asks for visit outcomes to verify bookings; the practice sends only whether a booked appointment took place, after counsel confirms the basis and the marketplace signs a business associate agreement covering it.

Checklist

Get the fee terms in writing, including what triggers each fee.
Have counsel check the fee against 42 USC 1320a-7b(b), Advisory Opinion 19-04’s factors and your state’s referral fee and fee-splitting laws.
Confirm whether patients covered by Federal health care programs can book the listed services.
Match listed prices to your own price page, and say what each price includes.
Route marketplace bookings into the same self-pay check and Good Faith Estimate steps as other bookings.
Decide in writing whether the marketplace is your business associate, and sign an agreement before sending patient information if it is.
Keep owners and staff from posting reviews without disclosure, and never tie an incentive to a positive review.
Review the listing each time your prices or services change.

How we help

We build websites, local and organic search, Google Ads and lead generation and an AI front desk for independent practices. For marketplace listings, that means listing copy and prices that match your own pages, bookings routed into the same intake and estimate steps as calls, and a check of what patient information reaches each vendor before it does. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. For the wider rules, see our healthcare marketing rules guide.

Is a per-booking fee to a marketplace a kickback?

Not automatically. The Anti-Kickback Statute turns on intent and applies when the booked services are payable by a Federal health care program (42 USC 1320a-7b(b)). OIG calls per patient fees particularly problematic, but in Advisory Opinion 19-04 it found low risk where fees were set in advance at fair market value, did not depend on insurance, and did not buy placement. State laws apply whoever pays.

Do we still owe a Good Faith Estimate when a patient books through a marketplace?

Yes, if the patient is uninsured or self-pay. Under 45 CFR 149.610 the duty sits with the convening provider, the one responsible for scheduling the primary service. The estimate is due within 1 business day of scheduling when the service is at least 3 business days away, and within 3 business days when it is at least 10 business days away.

Does a booking marketplace need a business associate agreement?

Only if it is your business associate: a person that creates, receives, maintains or transmits protected health information on your behalf (45 CFR 160.103). A service patients use on their own may not be. One you hire to run your scheduling likely is. Either way, what your practice sends it must be permitted under 45 CFR 164.502(a).

Can our marketplace price differ from the price on our website?

No federal rule we found requires the same price on each channel. Each price must not be deceptive under 15 USC 45, so a patient who books at the listed price should be charged it for what the listing describes. We recommend matching prices, or stating why they differ.

Can we offer patients something for reviewing us on the marketplace?

Not if it is conditioned on a particular sentiment. 16 CFR 465.4 bars compensation or incentives tied to a positive or negative review. A general request to share an honest experience is not covered by that section, but read the marketplace’s own review policy first.

Sources

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