Why HHS Abandoned “Mystery Shopper” Study

July 12, 2011 – In The News
American Medical News

Fox Rothschild's William Maruca was quoted in an article in American Medical News about a Department of Human Services postponed initiative to use mystery shoppers to determine the level of access to primary care physicians across the country.

Maruca said that, in general, limiting the number of Medicare patients compared with the number of appointment slots for private pay patients is not going to get practices in legal trouble. He said Physicians and practice administrators often set ratios for the right payer mix to keep practices financially sustainable. Depending on the insurer, some contracts for Medicare managed care might include language stating that practices can't turn away new patients. Individual states also may have laws against restricting access to patients with Medicaid coverage, he said.

"But it's permissible as far as traditional Medicare itself is concerned," Maruca said.

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