Perspective               

Boutique Medical Care Violates Medicare law

Over the past several months, Democratic members of Congress have launched a campaign against "boutique medical care"-a growing trend in health care aimed at circumventing the red tape of managed care. Boutique medical practices boast deluxe health care services, such as 24-hour availability and significantly more face time with doctors, for a membership fee in addition to the cost of insurance. For example, MDVIP, a boutique practice in Boca Raton, FL, requires patients to pay a $1,500 annual membership fee in exchange for an annual screening that is the basis for a wellness program that includes preventive services which are not covered by Medicare. Boutique care practices argue that it is legal for them to charge a hefty annual fee and still seek reimbursement from Medicare for Medicare-covered services since Medicare does not cover the services they offer in preventive care programs.

Some Democratic members of Congress contend, however, that boutique care practices still violate existing Medicare law. In a March 4 letter to Health and Human Services Secretary Tommy Thompson, Representatives Henry Waxman, Sherrod Brown, Pete Stark, and Benjamin Cardin, and Senator Richard J. Durbin pointed out two potential violations. The legislators said the fee charged by the practices like MDVIP often do cover services, like lab and diagnostic tests, that Medicare covers. They also noted that the annual fee violates the law limiting the amount doctors can bill their patients. For example, if Medicare approves $100 a visit for five visits during the year, the doctor would receive that $500 plus the $1,500 annual fee, a total of $2,000 for the year or $400 a visit.

Senator Bill Nelson (D-Fla), who sponsored the Equal Access to Care Act which would prevent boutique doctors from receiving Medicare reimbursement, believes the proliferation of such practices would lead to a dangerous "wealth care" movement. "All [people with Medicare] are entitled to health insurance by the federal government, not just those who can pay an entrance fee."

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