There is a fair amount of confusion afoot concerning the obligation or not of physicians to accept Medicare patients. There is no requirement that any physician accept Medicare patients or refrain from limiting the number of Medicare patients accepted into the physician’s practice. There are circumstances when it may be in the best interest of a physician to “opt out” of Medicare. The growth of concierge medicine in some respects makes it safer for physicians to “opt out” of Medicare in order to avoid stepping afoul of the Medicare fee limitations by charging for services that might be construed by CMS or the OIG as being extra contractual charges which might implicate the federal false claim statute. According to 2005, General Accounting Office Survey of providers of concierge medicine, only about 25% of them had opted out and were practicing on the cash only high wire without the Medicare safety net.
Physicians who “opt out” of Medicare have no limitation on the amounts they may charge their Medicare beneficiary patients. They must sign and deliver an “opt out” affidavit to HHS that they will not submit any Medicare claims or receive any direct or indirect payment from Medicare for the next two years. They must have a written contract with their patients which essentially takes the services provided outside of the Medicare program. The beneficiary must also agree not to submit claims for the services provided to Medicare and must assume the financial responsibility for all of the services provided by the opt out physician. This obviously is the safest and cleanest way to “opt in” to the world of concierge medicine. It some ways it is like climbing without a net. It can be scary and it pays not to look down, but it can produce an adrenaline rush.