EXCLUSIVE: Conservative Coalition Urges Dr. Oz to End Medicare’s ‘Paying Twice’ Problem

FIRST ON THE DAILY SIGNAL—A coalition of conservative and free-market groups is supporting a Trump administration proposal to prevent Medicare from paying twice for overlapping physician work performed during the same patient visit, which the coalition says also costs seniors.

Sixteen conservative groups, led by the 60 Plus Association, sent a letter to Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz Wednesday, supporting a rule CMS proposed in July.

“The issue CMS is addressing is straightforward in principle: Medicare should not pay twice for overlapping work performed during the same encounter,” the letter, first obtained by the Daily Signal, states.

The letter presents a hypothetical example: a senior visits a dermatologist to have a mole examined. The physician evaluates the patient and removes the mole during the same appointment. The dermatologist may then bill Medicare for both the office visit and the procedure, even though some of the physician work and resources for those services overlap.

Federal audits identified tens of millions of dollars in improper payments involving same-day office visits and procedures in specialties including ophthalmology and dermatology, the letter notes.

“Every dollar unnecessarily spent on duplicative payments is a dollar that cannot be used for patient care or other priorities,” the letter states.

Under the proposed rule, CMS would pay the highest-priced service at 100% and the additional applicable service or services at 50%.

The letter notes that many Medicare Part B beneficiaries share in the cost of their care through coinsurance, so unnecessary Medicare spending can translate to out-of-pocket costs for retirees living on fixed incomes. More than half of American seniors live on less than $2,000 per month, the coalition noted.

Physician groups have pushed back on the proposal. The American Medical Association argues that CMS has not justified the size of the payment reduction and warns it could harm independent medical practices.

“CMS hasn’t provided the evidence to justify a cut this large and there is already a process to address genuine overlap in payment,” the AMA argues. “When those services are distinct, physicians should be paid for both.”

CMS proposed a narrower version of the policy in 2018 but ultimately did not finalize it after physician groups objected. The current proposal would apply the reduction more broadly.

The letter’s signatories included the 60 Plus Association, the American Association of Senior Citizens, Citizens Against Government Waste, Taxpayer Protection Alliance, Hillsdale Policy Group, and other conservative and free-market organizations.

The agency is accepting public comments before finalizing the rule.

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