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of American Physicians and Surgeons, Inc.
A Voice for Private Physicians Since 1943
Omnia pro aegroto
A memorandum concerning the Wall Street Journal article "A
Victory for Private Medicine," July 29, 1999:
- The message was hardly unambiguous. A new undefined and
undefinable term was introduced: unwarranted.
- Senator Jon Kyl's constituent will receive little if any
benefit from the decision, because she apparently desires to
contract privately for necessary, covered services.
- Section 4507 is cogently described by John S. Hoff as "an
exception to nothing." It creates a safe harbor from
previous pronouncements by HCFA and Medicare carriers
concerning private contracting, which is nowhere explicitly
prohibited by statute.
- The proper term is "balance billing," not "balanced
billing." It refers to billing for the balance, i.e. the
difference between the market price and the Medicare
- Kent Masterson Brown filed the case of AAPS v. Clinton, but
withdrew in August, 1994. Since that time, Thomas Spencer of
Miami has represented AAPS in that case. Sanctions against
the defendants were imposed in December, 1997.
- The suit filed by Mr. Brown on behalf of four Medicare
beneficiaries (Stewart v. Sullivan) was decided in October,
1992. The author apparently has this confused with the case
filed on behalf of United Seniors Association, decided this
- Backpedaling by the Clinton administration occurred each
time a question was raised (as by Pat Rooney concerning
persons not enrolled in Part B). Nancy Ann Min DeParle made
the promises named by the Court in the decision when Jon Kyl
put a hold on her appointment.
- I think the ABN is a statutory provision; in any case, it
long antedated the United Seniors case.
- In the United Seniors case, only the narrow issues of
privately contracting for noncovered or unnecessary services
were involved. Plaintiffs explicity renounced any claim to
contract for covered services and in fact assumed that this
- The power of contract for covered services is very much
unresolved unless the physician exercises his right to opt
out of Medicare.