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Part B (physician services) from petitioner’s network of
providers, and petitioner was compensated by the Government for
each enrollee on a pre-paid, capitation basis. Between 1993 and
1998, Group offered a Medicare “cost” health plan of the same
name.8
Petitioner and Group ceased offering their respective Senior
Care plans effective December 31, 1998. Petitioner terminated
its Senior Care plan in part due to the financial losses that it
incurred under the program.
C. Enrollment
As of September 30, 1997, petitioner had 22,258 enrollees,
including 15,006 enrollees in IHC Care and 7,252 enrollees in IHC
Senior Care.
D. Lack Of Free/Low Cost Services
Petitioner did not provide any charity care. Petitioner did
not maintain a program designed to encourage or assist low income
persons, medically high-risk persons, persons located in
medically under-served areas, or elderly persons to enroll in its
8 Under Group’s Senior Care plan, Medicare eligible enrollees
who paid the required premium were entitled to obtain physician
services (and a number of additional services not covered by
Medicare) from petitioner’s panel of primary care physicians and
specialists and were relieved of the obligation to pay any
deductible or co-insurance payments under Medicare Part B
(physician services). Enrollees in Group’s Senior Care plan
retained their eligibility for Medicare Part A (hospital
services) and continued to pay Medicare Part A premiums to the
Government.
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