Sample Letter #3 Informing Medicare Patients of Decision to Opt-Out of Medicare

Within little more than 24 months, the Congress has passed and the President has signed into law profound changes in the Medicare Program, dramatically affecting both patients and physicians. The vast majority of these changes have not been made known to you as Medicare beneficiaries or to the general public. Many physicians are completely ignorant of these changes.

The most important statute produced new definitions of "fraud and abuse" for the Medicare Program. The occurrence of the simplest clerical error has now been redefined as "abuse" of the Medicare Program and each inadvertent clerical error is potentially subject to prosecution, with fines up to $2000 per error. Medicare has hired large numbers of individuals whom it pays a bounty for each error they believe they find. Medicare has asked the Justice Department to allow these individuals to carry firearms when they come to a doctor's office.

Very disturbingly, in secret meetings between the American Medical Association and Medicare, a new system of coding and medical record documentation was developed. This new coding and documentation system contains thousands of possible combinations for a single office visit. I have studied this new system and its revisions in detail and have found it virtually impossible to perform correctly. Further, the actual time required to document and process any Medicare visit will be lengthened greatly and will usually exceed the time spent with the patient.

After carefully reviewing all of these changes and risks, and after months of deliberation, I felt that I have had no choice but to resign from the Medicare Program. This anguishing decision was the most difficult one I have yet to have to make as a physician. It has been made with enormous reluctance and disappointment. I feel a tremendous sense of loss as it has been a privilege to know and care for my Medicare patients. Some of our relationships go back to when I started practice over 21 years ago, and long before many of you were even on Medicare.

I know this will come as a shock and may be disruptive and frustrating for you. It certainly has been for me. Please forgive the delay in letting you know sooner, as my father's recent illness and unexpected death made it difficult to write to you before this time.

I remain deeply committed to the practice of medicine at the level and according to the principles by which I was trained and I am not willing to sacrifice my commitment to those principles and what it means to your care.

For all of you whom I have seen after October 1, 1998 (my official Medicare resignation date), there has been no charge for your visits.

I will be happy to contract privately with you if you should wish to continue in my care. It will probably be much easier than you might imagine. Feel free to call me to discuss this very workable possibility. My staff and I will be happy to assist you in any way we can.

In an attempt to minimize the disruption this brings for you, I have spoken with several of the dermatologists in our area and they will be willing to take over care for anyone who wishes.

Thank you again for the opportunity to serve as your physician. It has been an honor. You will always be welcome to call on me.

Most sincerely yours,

Your Doctor