Compliance

Can you pay physicians for clinical trial referrals? Finder's fees explained

By TrialNotice · Updated
Senior physician in reading glasses reviewing a formal multi page document at a wooden desk with a red pen
Short answerPaying a physician solely for referring a patient to a clinical trial, known as a finder's fee, is unethical under the AMA Code of Medical Ethics and can raise federal Anti Kickback Statute concerns when Medicare or Medicaid services are involved. Paying fair market value for real work, such as reviewing charts against a protocol's criteria, is treated differently, and FDA has said such payments should be reviewed by the IRB.
This article is general information, not legal advice. Talk to your IRB and health care counsel before setting up any payment to physicians.

What is a finder's fee in clinical research?

A finder's fee is a payment to a physician or other referral source for a successful referral, meaning a referral that results in a patient enrolling. No specific regulation bans them, but they are generally considered inappropriate because they create a conflict of interest that could push a physician to encourage a patient who has doubts (WCG).

What does the AMA say?

The AMA Code of Medical Ethics states that payment by or to a physician solely for the referral of a patient is fee splitting and is unethical, and it lists payment for referring a patient to a research study as an example (AMA Code of Medical Ethics).

What does FDA say?

FDA has distinguished between a physician who simply passes along a patient's name and a physician who performs real work, such as reviewing patient charts, assessing patients against the protocol's inclusion and exclusion criteria, and discussing the study with the patient. Payment that reflects actual time and effort may be permissible, and FDA has said referral payments should be submitted to and reviewed by the IRB (Food and Drug Law Institute).

Do IRBs allow finder's fees?

It varies. A 2009 review of IRB policies at 117 medical schools found about a quarter prohibited investigators from offering finder's fees (American Medical News). Many IRBs today have policies against payments made solely for referrals (FDLI). Check your own IRB's written policy.

What do central IRBs say today?

WCG IRB does not allow referral fees for medical professionals or research staff, citing the AMA Code, and notes that some states ban the practice. It does allow reimbursement for activities directly related to performing the research, at a rate no higher than fair market value (WCG). Some academic IRBs go further: the University of Kentucky's Medical IRB will not approve finder's fees at all, based on legal and ethical concerns raised by its counsel and compliance office (University of Kentucky).

What about the Anti Kickback Statute?

Because the federal Anti Kickback Statute prohibits payment for referrals of services that may be reimbursed by Medicare or Medicaid, health care counsel have long advised that per patient referral incentives are inadvisable for Medicare patients (Nixon Peabody). Many states have similar laws (FDLI).

How can sites increase referrals without paying for them?

Money is not what holds most physicians back. Tufts CSDD found physicians name missing study information and time as the key reasons they do not refer (Tufts CSDD). Sites can address both directly:

  • Send relevant local physicians a clear one page study summary.
  • Give a named coordinator contact so referral takes one step.
  • Report back on every referral and share study results.
  • Follow up consistently by email and LinkedIn.

See how to get physicians to refer patients to your clinical trial.

Get your study in front of the right local physicians

TrialNotice builds a physician referral pipeline around one active study. We identify relevant local physicians within driving distance of your site, send study aligned direct mail, follow up by email and LinkedIn, track engagement with recipient level QR codes, and route warm responses into your site team's workflow.

Talk to TrialNotice

Sources

  1. AMA Code of Medical Ethics, Opinion on Fee Splitting
  2. WCG, "Clinical Trial Recruitment Practices: The Evolution of Ethical Considerations"
  3. WCG, "May I pay a physician for referring a patient to our study?"
  4. Food and Drug Law Institute, "Legal and Ethical Considerations for Offering Clinical Trial Recruitment Payments and Enrollment Incentives"
  5. University of Kentucky Medical IRB policy on finder's fees
  6. American Medical News, "Most IRB rules don't ban finder's fees for clinical trials" (2009)
  7. Nixon Peabody, "Ethical and Regulatory Implications of Payments for the Referral of Research Participants"
  8. Applied Clinical Trials, "Tufts CSDD Study Explores Low Recruitment Rates"

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