Last week the HHS Inspector General posted a rare alert that seemed to green-light a controversial practice of physicians charging Medicare beneficiaries extra money for services.
However, while the two-page alert may have blessed the concept of "boutique" or "concierge" care for the first time, the inspector general's office does not define or identify what is acceptable under the practice.
Rather, Acting Principal Deputy Inspector General Dara Corrigan clearly described what it is not.
". . . When participating providers request any other payment for covered services from Medicare patients, they are liable for substantial penalties and exclusions from Medicare and other federal healthcare programs," Corrigan said in the alert. "We are hearing reports about physicians asking patients to pay additional fees, and we believe this is an ideal time to remind physicians and Medicare patients about this potential liability."
Charging additional fees for services already covered "abuses the trust of Medicare patients" by making them pay again, Corrigan said.
The alert cites a recent settlement with Minneapolis internist R. Douglas Thorsen, M.D., who in July 2003 agreed to pay $53,400 to resolve his liability for violating his Medicare provider?s assignment agreement.
Beginning in 1998 and into 2001, Thorsen asked his patients to sign a yearly contract and pay a yearly fee of $600 for services not covered by Medicare. Included within that list were "coordination of care with other providers," a comprehensive assessment and plan for optimum health and extra time spent on patient care. However, the inspector general charged that many of those services already were covered by Medicare and that Thorsen violated Medicare laws.
In addition to paying the monetary penalties, Thorsen agreed to stop offering the contracts and could have faced exclusion.
Mac Thornton, a Washington attorney and former chief counsel to the inspector general, said this alert marks the first time the agency has addressed the issue of providers charging Medicare beneficiaries extra money for services. But Thornton doesn?t predict a rush of physicians launching their own concierge-care billing programs and cautioned doctors about the potential liability and exclusion penalties they could face.
"In actual practice it may not be so easy to come up with a list of things to charge extra for," said Thornton, who is with the firm Sonnenschein, Nath & Rosenthal.