Skyrocketing malpractice premiums have prompted some physicians to require patients to sign waivers agreeing not to sue, according to 

(5/17/04). In addition, a growing number of physicians are charging extra fees for services such as telephone consultations or completing disability or insurance forms. 

Defending the actions of these physicians, Paul Kitchen, executive vice president of the Medical Society of Virginia, told 

 (5/04), "This is about recovery of lost income, rather than a revenue-making scheme."

 However, others recommend caution when implementing these practices. For one,   it's uncertain whether patient waivers will stand up in court. For another,   charging extra to Medicare patients for services that were once free may violate   the terms of federal health programsa breach that the U.S. Department   of Health and Human Services recently warned could result in physicians facing   fines or being barred from participation. 