A dentist receives a payment from a specialist for each patient referred. Under which term does this practice fall?

Correct answer: C. Fee splitting

• A. Capitation is a fixed per-patient periodic payment to a provider regardless of services delivered.
• B. Upcoding is billing for a more complex or expensive procedure than the one actually performed — a form of insurance fraud.
• C. Correct. FEE SPLITTING (a kickback or rebate for referrals) is unethical under the ADA Principles and is illegal under federal anti-kickback statutes. It corrupts the referral decision: the patient can no longer trust that they were sent to a particular specialist because that specialist was genuinely best for them. Referrals must rest solely on clinical judgement and patient benefit.
• D. Balance billing is charging the patient the difference between the fee and the insurer's allowed payment.