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Medicare. Medicare did not reimburse petitioners for nondrug
supplies used in administering treatments. Some private
insurers, however, did cover these charges.
With respect to chemotherapy drugs, petitioners' claims for
reimbursement included only charges for chemotherapy drugs
prepared from petitioners' own supply and administered by
petitioners’ nursing staff to the patient.
When petitioners received a payment from Medicare or an
insurance company, they also received an "Explanation of
Benefits" (EOB), which detailed amounts allowed and disallowed as
to each specific charge and amounts due (copay amounts) from
secondary insurance or the patient as to each specific charge.
Petitioners routinely wrote off disallowed charges as they
received EOB’s from the insurance companies. Petitioners wrote
off the disallowed charges because agreements with the insurance
companies prevented petitioners from seeking payment for those
charges from the patients directly. Copay amounts were not
written off as long as the patient continued to receive
treatments, even if the patient was indigent or full payment was
not otherwise expected. Petitioners kept daily, monthly, and
annual summaries of charges, reimbursements, and writeoffs.
When PC's billing office determined from an EOB that an
allowable charge had been disallowed, a corrected bill or
explanation was submitted, and the writeoff of the disallowed
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