Daily deal and group-buying sites for medical practices: fee-splitting and discount rules

A daily deal or group-buying site sells a voucher for your service to its own audience, collects the money, keeps its share and sends you the rest. For a retailer that is a marketing cost. For a licensed practice it can be something else: when the site keeps a percentage of the fee for each patient it brings in, the arrangement can look like fee splitting or a payment for referrals, which state licensing law and professional ethics codes restrict. The voucher page also makes price and value claims that the FTC Act reaches, and a voucher with a stated dollar value can fall under the federal gift card rule.

This guide covers what to check before a med spa, dental office, chiropractic clinic or medical practice runs a deal: the fee structure, the state and professional rules we read, the federal rules for patients in Medicare and Medicaid, the value claim on the voucher page, expiration terms and what you share back with the deal company. For related topics, see our guides to gift cards, holiday promotions and package deals, price matching and competitor coupons and teacher, first responder and healthcare worker discounts.

The short version

• The fee model matters more than the discount. A deal site that keeps a percentage of what each patient pays is paid in a way that the ethics code and the state laws we read treat with suspicion. A flat advertising fee is easier to defend.
• The American Dental Association Code says a dentist who lets a coupon company collect the fee, keep a defined percentage and remit the rest is engaged in fee splitting.
• New York, California and Florida each restrict payments for referrals or fee sharing in their own words. Ask counsel how your state and your board read a deal contract.
• If the service could be paid by Medicare, Medicaid or another federal health care program, the federal Anti-Kickback Statute and the beneficiary inducement penalty come into play. We recommend keeping deals to services no federal program pays for.
• A “value” or “regular price” on the voucher page must be a real price. The FTC pricing guides say a former price must be one you actually charged for a reasonably substantial period.
• A voucher for a specific treatment is generally outside the federal gift card rule, but one that states a dollar value is generally inside it, with its five-year minimum expiry for the funds.
• A voucher is not a treatment plan. Plan for buyers who turn out not to be candidates, and for what you send back to the deal company.

How a daily deal works, and where the money goes

The deal company lists your offer, sells vouchers to its subscribers and visitors, and takes payment from the buyer. The buyer later books with you and presents a voucher code. The deal company then pays you an amount set by your contract. The contract sets how the deal company is paid: it may keep a percentage of each voucher sold, charge a flat listing fee, or combine the two. We do not quote figures here because the terms are set deal by deal. Read your own contract for the split, the payment schedule and what happens to vouchers that are bought but never redeemed.

Three questions shape the legal analysis. Who collects the patient’s money? How is the deal company paid: a fixed fee for the listing, or a share of each patient fee? And could any part of the service be billed to an insurer or a government program? Write the answers down before you talk to counsel.

Why a percentage fee raises fee-splitting questions

The clearest written statement we found comes from dentistry. Advisory Opinion 4.E.1 of the American Dental Association Code, Split Fees in Advertising and Marketing Services, says the prohibition against accepting or tendering rebates or split fees applies to business dealings with any third party, not just other dentists. It says a dentist who pays a specific amount or percentage of professional fees collected from actual or prospective patients to a vendor for advertising or marketing services is engaged in fee splitting. It names “social coupons” directly: the prohibition applies if the arrangement allows the issuing company to collect the fee from the prospective patient, retain a defined percentage or portion of the revenue as payment for the coupon marketing service and remit the remainder to the dentist. The ADA Code binds ADA members, and the opinion adds that state laws or regulations may also address how revenue from prospective patients is divided with an advertising vendor.

New York Education Law section 6530 lists professional misconduct for physicians. Paragraph 18 covers directly or indirectly offering, giving, soliciting or receiving any fee or other consideration to or from a third party for the referral of a patient or in connection with the performance of professional services. Paragraph 19 covers permitting any person to share in the fees for professional services, other than a partner, employee, associate in a professional firm or corporation, professional subcontractor or consultant authorized to practice medicine, or a supervised trainee. It adds that the prohibition includes arrangements where the payment for space, facilities, equipment or personnel services is a percentage of, or otherwise dependent on, the licensee’s income or receipts from the practice, with exceptions for facilities licensed under other laws.

California Business and Professions Code section 650(a) makes it unlawful for a licensee to offer, deliver, receive or accept any rebate, refund, commission, preference, patronage dividend, discount or other consideration as compensation or inducement for referring patients, clients or customers to any person. Section 650(b) says a payment for services other than the referral of patients that is based on a percentage of gross revenue or a similar arrangement is not unlawful if it is commensurate with the value of the services furnished. That wording puts the question on whether the deal company is paid for advertising worth what it charges, or paid for each patient it sends.

In Florida, section 456.054 makes it unlawful for any health care provider to offer, pay, solicit or receive a kickback, directly or indirectly, for referring or soliciting patients, and defines a kickback as a payment to any person as an incentive or inducement to refer patients when the payment is not tax deductible as an ordinary and necessary expense. Violations are treated as patient brokering under section 817.505. For physicians, section 458.331(1)(i) lists as grounds for discipline paying or receiving any commission, bonus, kickback or rebate, or engaging in any split-fee arrangement in any form whatsoever, for patients referred to providers of health care goods and services.

These are three states and one professional code. Your profession, your state and your board may use different words or have issued their own opinion on deal sites. We recommend asking counsel two direct questions: does a percentage-of-voucher fee count as fee splitting or a referral payment for my license in my state, and would a flat listing fee change the answer?

Patients in Medicare, Medicaid and other federal programs

The federal Anti-Kickback Statute, 42 USC 1320a-7b(b)(2), makes it a felony to knowingly and willfully offer or pay any remuneration, directly or indirectly, to any person to induce them to refer an individual for, or to arrange for or recommend, any item or service for which payment may be made in whole or in part under a Federal health care program. Paragraph (b)(1) covers the person who solicits or receives such a payment. The statute sets a fine of not more than 100,000 dollars, imprisonment of not more than 10 years, or both. Under 42 USC 1320a-7a(a)(7), the same conduct can bring a civil money penalty of not more than 100,000 dollars for each act, plus damages of up to 3 times the total remuneration.

A second civil penalty reaches the patient side. Under 42 USC 1320a-7a(a)(5), a person who offers or transfers remuneration to an individual eligible for Medicare or a State health care program, knowing or having reason to know it is likely to influence the individual to order or receive from a particular provider any item or service payable by Medicare or a State health care program, is subject to a civil money penalty of not more than 20,000 dollars for each item or service. Section 1320a-7a(i)(6) defines remuneration to include the waiver of coinsurance and deductible amounts and transfers of items or services for free or for other than fair market value, subject to listed exceptions. HHS adjusts these amounts for inflation each year in the table at 45 CFR 102.3, so read the current table rather than the figure in the statute.

Both provisions turn on services that a federal or state program may pay for. A cosmetic service that no program covers is a different case from a discounted exam that leads to covered care. We recommend limiting deals to services that no federal or state health care program pays for, stating that on the voucher, and asking counsel before any deal touches a service you also bill to Medicare or Medicaid.

Value claims on the voucher page

The voucher page is your advertising, even when the deal company writes it. Under 15 USC 45(a)(1), unfair or deceptive acts or practices in or affecting commerce are unlawful, and 15 USC 52 prohibits any false advertisement likely to induce the purchase of food, drugs, devices, services or cosmetics. Approve the copy before it goes live. Plan capacity for the vouchers you sell and honor them on their stated terms; our guide to bait and switch in healthcare ads covers offers that bring patients in and then steer them to something else.

The FTC Guides Against Deceptive Pricing set out how the FTC reads price comparisons. 16 CFR 233.1 says a former price is a legitimate basis for a comparison if it is the actual, bona fide price at which the article was offered to the public on a regular basis for a reasonably substantial period of time, and that a price inflated so a large reduction can be advertised makes the bargain a false one. It adds that the advertiser should avoid implying a former price was a selling price, rather than an asking price, unless substantial sales at that price were actually made. 16 CFR 233.2 says that when an advertiser claims to sell below the prices charged by others in its trade area, the higher price must not appreciably exceed the price at which substantial sales are being made in the area. A “value” figure on a voucher should be your own regular price, or a local comparison you can document.

We recommend keeping a record of the regular price, the period it was charged and the number of times it was paid before the deal runs. If the service is new and has no regular price yet, describe the voucher price on its own rather than as a discount. Our guide to price matching and competitor coupons covers comparison claims in more depth.

Expiration dates and the federal gift card rule

Regulation E, 12 CFR 1005.20, sets federal rules for gift certificates, store gift cards and general-use prepaid cards. Each definition requires a card, code or other device issued on a prepaid basis to a consumer “in a specified amount.” The official interpretation, comment 20(a)-3 in Supplement I to Part 1005, speaks to vouchers for a specific service. It says cards or codes redeemable for a specific good or service or experience, such as a spa treatment, generally are not subject to the section because they are not issued in a specified amount. It adds that a certificate issued in a denominated amount that can be applied toward a specific service, such as one redeemable for a spa treatment up to a stated dollar amount, is subject to the section, and so is a card or code that states a specific monetary value, unless an exclusion in 1005.20(b) applies.

When the rule applies, 12 CFR 1005.20(e) bars selling or issuing a covered certificate or card with an expiration date unless, among other conditions, the expiration date for the underlying funds is at least the later of five years after issue or last load, or the card’s own expiration date, and the expiration terms are disclosed on the certificate or card. The exclusions in 1005.20(b) include loyalty, award or promotional gift cards that carry required disclosures, and cards not marketed to the general public. Our guide to gift cards, holiday promotions and package deals covers the fee and disclosure rules.

A deal voucher may show both a paid amount and a promotional amount. How the paid portion and the promotional portion are treated after the promotional period ends is a question for counsel under your contract and your state law, which we did not review for this guide.

A voucher is not a treatment plan

A buyer pays before anyone at the practice has seen them. A buyer may not be a candidate for the service, may need a different service, or may need a medical history review first. We recommend writing three things into the voucher terms and your intake process before the deal runs: that each buyer is evaluated before treatment, what happens if the buyer is not a candidate, and how a refund is handled. The decision to treat stays with the licensed clinician, whatever the voucher says.

Plan for demand as well. A deal page can bring more bookings in a short period than your schedule holds. Decide the number of vouchers you can honor, set a limit with the deal company if your contract allows one, and tell buyers how to book.

What you share back with the deal company

Redemption means confirming a voucher code with the deal company. Once a buyer becomes your patient, what you know about them through your practice is subject to HIPAA if you are a covered entity. Under 45 CFR 164.502(a), a covered entity may not use or disclose protected health information except as the Privacy Rule permits. We recommend sending the deal company only what the contract needs to pay you, such as the voucher code and the redemption date, and never clinical details, treatment notes or reasons a buyer was turned down.

Under 45 CFR 164.501, marketing means a communication about a product or service that encourages the recipient to purchase or use it, with exclusions for treatment communications and for describing the covered entity’s own health-related services unless it is paid to make the communication. 45 CFR 164.508(a)(3) requires written authorization for marketing uses of protected health information. If the deal company offers to email your existing patients, or asks for your patient list to target its next promotion, treat that as a HIPAA question for counsel before any list leaves the practice.

Questions to ask a deal site before you sign

• Is your fee a flat listing fee or a share of each voucher sold, and can the contract be written as a flat fee?
• Who collects the buyer’s money, and when and how is the practice paid?
• Can we set the number of vouchers sold and the dates they may be redeemed?
• Can we approve the voucher page, the value claim and the fine print before the deal goes live?
• What exactly do you need from us at redemption, and what do you do with it?
• How are refunds handled when a buyer is not a candidate for the service?
• What happens to the paid amount if a voucher is not redeemed by its promotional date?
• Will you use our name or the voucher buyers’ information to market anything else?

Use and avoid

• Use: a flat advertising fee where the deal company will agree to one, after counsel reviews it.
• Use: deals limited to services that no federal or state health care program pays for.
• Use: a value figure that is your documented regular price.
• Use: voucher terms that say each buyer is evaluated before treatment and explain refunds.
• Use: a cap on vouchers that matches the appointments you can offer.
• Avoid: contracts that pay the deal company a percentage of each patient fee without a written legal review.
• Avoid: inflated “regular” prices set to make the discount look larger.
• Avoid: deals on exams or services you also bill to Medicare or Medicaid.
• Avoid: outcome promises, before-and-after claims or urgency lines written by the deal company.
• Avoid: sending clinical details or patient lists to the deal company.

An illustration

This example is invented. [Practice name], a med spa in [city], is offered a deal listing for a facial treatment. The draft contract lets the deal company collect the voucher price, keep a fixed percentage of each voucher sold and remit the rest. The draft page lists a “value” that is higher than any price the med spa has charged, promises “visible results after one visit” and gives the vouchers a short expiration date with no mention of evaluation or refunds.

The owner sends the contract to their health care attorney, who asks how the percentage fee fits the state’s rules on referral payments and fee sharing. The med spa asks the deal company for a flat listing fee and for approval of the page. The value line is changed to the regular price the med spa has charged for the past year, the results promise is removed, the page states that each buyer is evaluated before treatment and that buyers who are not candidates receive a refund, and the expiration terms are reviewed with counsel. The med spa caps the number of vouchers at the appointments it can offer in the redemption window and agrees to send the deal company only voucher codes and redemption dates.

Checklist

• Write down who collects the money, how the deal company is paid and whether any program or insurer pays for the service.
• Have counsel review the fee structure under your state’s referral, fee-splitting and patient brokering rules and your board’s position.
• Dentists: read ADA Advisory Opinion 4.E.1 on split fees in advertising and marketing services.
• Keep deals to services no federal or state health care program pays for, and say so on the voucher.
• Document the regular price before you publish a value or discount.
• Approve the voucher page and fine print yourself; remove outcome promises and false urgency.
• Check whether the voucher states a dollar value, and if so review 12 CFR 1005.20 and your state’s rules on expiration with counsel.
• Write evaluation, refund and booking terms into the voucher and your intake process.
• Set a cap on vouchers that your schedule can honor.
• Limit what you send the deal company to the voucher code and redemption date.

How we help

We build websites, local and organic search, Google Ads and lead generation and an AI front desk for independent practices. For a practice weighing a daily deal, that means building offer pages on your own site with documented prices and clear terms, so you can compare the deal against advertising you pay for at a flat cost, and keeping booking and intake in your control. 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. Read our guide to healthcare marketing rules for the wider picture.

Sources

• 42 USC 1320a-7b: Criminal penalties for acts involving Federal health care programs (subsection (b), illegal remunerations)
• 42 USC 1320a-7a: Civil monetary penalties (subsections (a)(5), (a)(7) and (i)(6))
• 45 CFR 102.3: Penalty adjustment and table
• 16 CFR 233.1: Former price comparisons
• 16 CFR 233.2: Retail price comparisons; comparable value comparisons
• 12 CFR 1005.20: Requirements for gift cards and gift certificates
• 12 CFR Part 1005, Supplement I: Official Interpretations (comment 20(a)-3)
• 45 CFR 164.501: Definitions (marketing)
• 45 CFR 164.502: Uses and disclosures of protected health information: general rules
• 45 CFR 164.508: Uses and disclosures for which an authorization is required (paragraph (a)(3), marketing)
• 15 USC 45: Unfair methods of competition unlawful
• 15 USC 52: Dissemination of false advertisements
• Florida Statutes section 456.054 (2026): Kickbacks prohibited
• Florida Statutes section 458.331 (2026): Grounds for disciplinary action, paragraph (1)(i)
• California Business and Professions Code section 650
• New York Education Law section 6530: Definitions of professional misconduct (paragraphs 18 and 19)
• American Dental Association: Principles of Ethics and Code of Professional Conduct, Advisory Opinion 4.E.1 (advisory opinions revised to October 2025)

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