ANNAPOLIS – U.S. Rep. Benjamin L. Cardin today announced plans to introduce the Medicare PPO Fairness Act when Congress returns in mid-November requiring the Medicare program to reimburse beneficiaries who were illegally denied access to the physicians of their choice by preferred provider organizations (PPOs). It also will require the Medicare administrator to immediately notify all 98,000 PPO enrollees that they are entitled to services by providers both in- and-out-of-network.

The legislation stems from a recent non-partisan Government Accountability Office (GAO) report showing that private health plans violated the Medicare law by limiting patients’ access to the health care providers of their choice. The report also found that private health plans increased out-of-pocket costs for beneficiaries and cost the government approximately $700 a year more for each senior than if patients had remained in traditional Medicare.

The study also found that the Bush Administration "exceeded its authority" by allowing 29 of the 33 PPO plans to limit patients’ choice of providers offering skilled nursing and home health care, dental care and routine physical exams. The report found that beneficiaries who went outside the PPO network were often liable for the full cost of their care, a violation of law that requires private plans to cover all services in their benefit packages whether the provider is in- or out-of-network.

"The GAO report clearly shows that Medicare beneficiaries were illegally denied care by physicians of their choice. We must ensure that this never happens again by informing Medicare PPO beneficiaries they are entitled to services both in- and out-of-network, and refunding money that was paid by beneficiaries for services they were entitled to receive," said Rep. Cardin.

"This report is particularly troubling because, for years, Medicare has overpaid private plans for treating seniors, and the new Medicare law will give them an additional $14 billion. We cannot allow PPOs to receive money for services they are not providing."

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