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Association 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:

  1. The message was hardly unambiguous. A new undefined and undefinable term was introduced: unwarranted.
  2. 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.
  3. 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.
  4. 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 reimbursement.
  5. 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.
  6. 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 July.
  7. 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.
  8. I think the ABN is a statutory provision; in any case, it long antedated the United Seniors case.
  9. 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 is prohibited.
  10. The power of contract for covered services is very much unresolved unless the physician exercises his right to opt out of Medicare.