Judge Allows Doctors to Delay Participating in Medicare Fees

LUBBOCK, Tex. —  The nation’s doctors won the first round of a legal battle with the U.S. government Tuesday when a judge granted their plea to postpone a deadline for deciding whether to participate in Medicare.

U.S. District Judge Halbert O. Woodward granted a 10-day temporary restraining order and scheduled a hearing Jan. 9 to hear more evidence from the American Medical Assn. and other plaintiffs against the secretary of health and human services, Otis R. Bowen.

Woodward’s order means that doctors will not have to decide by Thursday whether to sign participation agreements locking them into a fee structure determined by the federal government.

The order also prevents the health agency from pursuing sanctions against physicians who do not sign up and charge fees the government may find questionable.

Stems From Dec. 24 Suit

Tuesday’s hearing stemmed from a suit filed Dec. 24 by the AMA, the Texas Medical Assn., the Lubbock-Crosby-Garza County Medical Society, seven Lubbock doctors and three of their patients.

The plaintiffs say doctors should not be required to decide on participation since they are not likely to receive information concerning fees they can charge until March.

The suit challenges as unconstitutional and unfair a section of the Omnibus Budget Reconciliation Act, signed by President Reagan on Oct. 21, and an amendment to the Social Security Act.

Doctors who participate in Medicare will not be allowed to charge those patients more than the government tells them to, the suit says. Also, it claims, Medicare recipients cannot use their own money to buy more expensive doctors or services.

Asserts Right to Choose

Additionally, Medicare recipients who go to non-participating doctors are reimbursed for 96% of what is paid to patients of participating physicians. That is unconstitutional, the suit says, because it denies patients the right to choose a doctor and receive equal care.

The doctors also are complaining about the method Bowen has chosen to calculate reimbursements.

Beginning Jan. 1, non-participating doctors may not charge a Medicare patient more than the “maximum allowable actual charge,” or MAAC, without facing possible sanctions.