Osteopathic Medical Oncology and Hematology, P.C. - Page 23




                                       - 23 -                                         

               Our declining to attach accounting significance to the bills           
          is supported by Federal Medicare statutes and regulations.  As              
          stipulated by the parties, the chemotherapy treatments and drugs            
          at issue are covered by Medicare.  Medicare covers only medical             
          "services" and does not cover prescription drugs that can be                
          self-administered.  See 42 C.F.R. sec. 410.29 (1998).5  In                  
          creating legislative coverage for medical services, Congress was            
          astutely aware that health care providers may need to use                   
          supplies or administer drugs incident to and as an integral part            
          of their services.  As pertinent, the Health Insurance for Aged             
          Act, Pub. L. 89-97, sec. 1861, 79 Stat. 291, 321 (1965), 42                 
          U.S.C. sec. 1395x(s) (1994), provides as follows:                           
                    The term "medical and other health services" means                
               any of the following items or services:                                
                    (1) physicians' services;                                         
                    (2)(A) services and supplies (including drugs                     
                    and biologicals which cannot, as determined                       
                    in accordance with regulations, be self-                          
                    administered) furnished as an incident to a                       
                    physician's professional service, of kinds                        
                    which are commonly furnished in physicians'                       
                    offices and are commonly either rendered                          
                    without charge or included in the physicians'                     
                    bills.                                                            

               5 This is true for the fee-for-service statutory coverage              
          under Medicare.  The Secretary of Health and Human Services may             
          contract with private insurers (health maintenance organizations)           
          to provide benefits to beneficiaries under Medicare.  See Health            
          Insurance for Aged Act, Pub. L. 89-97, 79 Stat. 291 (1965), 42              
          U.S.C. sec. 1395mm (1994).  The beneficiaries that opt for                  
          coverage under a health maintenance organization plan may have              
          prescription drug coverage under their contract with the insurer.           




Page:  Previous  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  Next

Last modified: May 25, 2011