[19971021]97-944_医疗保险：私人合同.pdf

Congressional Research Service The Library of CongressCRS Report for CongressReceived through the CRS Web97-944 EPWUpdated October 21, 1997Medicare: Private ContractsJennifer OSullivanSpecialist in Social LegislationCecilia O. EcheverraAnalyst in Social LegislationEducation and Public Welfare DivisionSummaryPrivate contracting is the term used to describe situations where a physician and apatient agree not to submit a claim for a service which would otherwise be covered andpaid for by Medicare. Under private contracting, physicians could bill patients at theirdiscretion without being subject to upper limits specified by Medicare. The Health CareFinancing Administration (HCFA, the agency that administers Medicare) had interpretedthe law to preclude such private contracts. Some physicians recommended that the lawbe modified specifically to allow such arrangements. The Balanced Budget Act of 1997 (BBA 97) included language permitting alimited opportunity for private contracting, effective January 1, 1998. However, if andwhen a physician decides to enter a private contract with a Medicare patient, thatphysician must agree to forego any reimbursement by Medicare for 2 years. The patient