WASHINGTON – Rep. Benjamin L. Cardin today introduced legislation prohibiting doctors who charge Medicare beneficiaries "membership" or "access" fees as a condition of receiving treatment from billing Medicare for their services.

The Medicare Equal Access to Care Act would disqualify physicians who charge beneficiaries fees in order to receive covered services from billing Medicare for two years.

"Medicare was created in 1965 to ensure access to care for elderly and disabled Americans. The law is clear in protecting Medicare patients against excessive charges. But premium practices undermine those protections and threaten access to and continuity of care, " the Congressman said. "My legislation will ensure that physicians cannot increase their incomes arbitrarily at the expense of seniors, who have fixed incomes."

By participating in Medicare, physicians agree to accept Medicare’s allowable charge for covered services as payment in full. Alternatively, doctors may choose non-participating status, which permits them to bill patients up to 15% above the Medicare reimbursement rate. Congress enacted these protections against excessive overbilling in 1989. In 1997, Congress further strengthened these protections by requiring doctors who choose to bill patients directly for covered services through "private contracting" to opt-out of the Medicare program for two years.

Through "premium practices," physicians seek to circumvent these billing limits. A growing number of doctors are informing their patients that they must pay a substantial annual fee -- ranging from $1,500 to more than $12,000 -- in order to continue seeing receiving care. In some cases, their fee covers the promise of "personal attention" and a "guarantee" that they will receive services that are already covered by Medicare.

"Membership in these exclusive practices is not a viable option for many beneficiaries. Annual incomes for seniors average under $15,000, and most cannot afford their prescription drug costs, much less thousands of dollars for the privilege of seeing a physician." Rep. Cardin noted. "Congress should act at once to constrain this practice and protect our seniors."

Rep. Cardin, a senior member of the Committee on Ways and Means, was joined by Government Reform Committee Ranking Member Henry Waxman (D-CA), Ways and Means Health Subcommittee Ranking Member Pete Stark (D-CA), Energy and Commerce Health Subcommittee Ranking Member Sherrod Brown (D-OH), and Gerald Kleczka, (D-WI), a member of the Ways and Means Health Subcommittee.