Clarification of Provisions Regarding Private Contracts Between Physicians and Beneficiaries

HEHS-98-98R: Published: Feb 23, 1998. Publicly Released: Feb 25, 1998.

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William J. Scanlon
(202) 512-7114


Office of Public Affairs
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GAO reviewed information about section 4507 of the Balanced Budget Act of 1997 (BBA) and issues regarding beneficiaries' access to physicians and their options for private contracting.

GAO noted that: (1) available information indicates that Medicare beneficiaries have ready access to physicians; (2) overall, about 96 percent of physicians accept and treat Medicare patients; (3) while 4 percent of beneficiaries report difficulty obtaining physician care, the amount that Medicare reimburses physicians does not appear to be the cause of this difficulty; (4) Medicare beneficiaries continue to be able to pay out of pocket whenever they do not want a claim submitted on their behalf or when they want to obtain services Medicare does not cover; (5) in addition, section 4507 of the BBA offers beneficiaries a new option for obtaining services from physicians willing to enter into private contracts; (6) however, much of the information that GAO reviewed on this topic contained inaccurate statements or omitted important details; and (7) for example, several documents falsely claimed that the private contracting provisions of the BBA limit, rather than expand, beneficiaries' options for seeking care from physicians.

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