Plodding my way through the legislation, it appeared that they covered potential work-arounds pretty well. I’ve been wondering whether a group practice might have a “doctor of record” to do the Medicare billing with the other physicians doing the actual treatment. From the looks of it, the DOR would have to avoid any payment to the other physicians, which sort of eliminates the rationale.
I guess you could have two doctors, a Medicare doctor and a non-Medicare doctor, but that raises some continuity of care issues.
I agree that they have probably thought long and hard to eliminate loopholes, but inevitably, loopholes will be found.
The intermediary, providing cash services to Medicare patients could locate offshore, thus avoiding some of the legal hazards of the law. The intermediary could promote their service to Medicare patients as a way to see the best doctors without delay. The doctor might still take on the Medicare patient at the usual Medicare rate, but the intermediary would pay the doctor a fee to see the patient quickly.
As far group practices are concerned, I believe that as long as the doctors bill under their own number, the doctor can decide, as an individual, whether they take Medicare/Medicaid or not. The opt out of Medicare applies to the individual doctor, not the group. I would expect that more of these hybrid practices to become more common. The non-Medicare doctor would purposely be the person responsible for urgent visits or some other important service. So if the Medicare or crap-care patient needs to get in and see someone right away, they will have to see the non-contracted physician, or else, they will have to go to the ER.