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HRD-79-111 1 (1979-09-06)

handle is hein.gao/gaobaazqk0001 and id is 1 raw text is: 


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RE:PORT BY THE


Comptroller General


OF THE UNITED STATES


             A cce ,u -:     :L,,:, ..: -.! of pecific approval


Com             srison Of Physicia

And Allowances Under Private Health

Insurance Plans And Medicare



GAO compared samples of physician charges
and allowances at six Medicare carriers and
found that physicians usually charge Medicare
ritients the same as other patients, but that
Medicare usually allow- less for physician's
services than do private health insurance
plans.
HEW headquarters officials said they do not
know the intent of the provision in the Medi-
care law which says, in effect, that charges al-
lowed as reasonable under Medicare should
not be higher than charges allowed under
Medicare carriers' private business in compara-
ble circumstances. As a result, HEW regional
offices, which make determinations of com-
parability, do not have guidelines for making
consistent decisions.

The Subcommittee should consider deleting
the comparability language from the law or
should clarify it.


      HRD-I79- 11
SEPTEMBER 6, 1979

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