Mid Del Therapeutic Center, Inc. - Page 11

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            chemotherapy drugs for both Medicare and private insurers, the                             
            reimbursement policies of the private insurers changed                                     
            frequently, affecting the amount that petitioners actually                                 
            collected and the predictability of the billing and collection                             
                  Petitioners' bills also included charges for Dr. Ishmael's                           
            professional services,5 administration of the chemotherapy                                 
            treatments, other supplies, miscellaneous medications, and                                 
            laboratory items.                                                                          
                  Determinations regarding reimbursement of charges were made                          
            by Medicare and private insurers on an item-by-item basis.                                 
            Medicare and the insurance companies took similar positions                                
            regarding some items.  For example, neither Medicare nor the                               
            insurance companies paid for unapproved chemotherapy treatments.                           
            Thus, petitioners were reimbursed for chemotherapy drugs used                              
            during chemotherapy treatments only if the drug administered to                            
            the patient had been approved for that specific therapeutic                                
                  The reimbursement policies of Medicare and the private                               
            insurers with respect to other items differed.  For example, the                           
            extra cost incurred by petitioners for a staff pharmacist to mix                           
            the chemotherapy treatments was not specifically reimbursed by                             

                  5Mid-Del did not bill patients or insurers for Dr. Ishmael’s                         
            professional services.  Instead, PC billed patients and insurers                           
            for all of the doctor’s services, wherever provided.                                       

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Last modified: May 25, 2011