THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
Date: Tue, 02 Oct 2007 08:44:34 -0700
05 00430 61 07100201
Ms. Lee Faleafine
Customer Representative
Division of Medicare Health Plans Operations
CMS Region 9
Centers for Medicare & Medicaid Services
90 7th Street Suite 5-300 (5W)
San Francisco, CA 94103 6706
..
Subject:
Statute Clinical Trial Self-referral
Dear Lee,
Last week on September 27, we received a
call from Cathy Windfield-Jones with
CMS. She suggested calling your office at 415 744 3617 to assist in resolving
a payment issue with Kaiser. Millie has been treated for breast cancer at
Kaiser in Walnut Creek, CA since 2002, and was referred for treatment at
UCSF on a clinical trial beginning on 070130 (2007, January, 30).
..
Though not presented when the
doctor made the referral on 070105 in
August Millie began getting a lot of
invoices, now over 100, from UCSF backdated for treatment in January
that total over $4K for treatments prescribed by Kaiser and performed by UCSF.
Annualized amount is $10K, nearly 10 times the amount of insurance
premiums.
..
I met with UCSF's accounting rep, Bob Schwartz, on 070830. Bob indicated
UCSF does not know the basis for their charges,
except that Kaiser's Medicare unit
calculates the amount UCSF bills Millie, and justification is based on Kaiser's
determination that
Millie can "self-refer" for participation in a clinical
trial.
..
Our question to CMS is whether Medicare support for patients to "self-refer" to
clinical trials, prohibits Kaiser from referring patients for treatment in
clinical trials, as Kaiser has been doing in this case since 2002, shown by the
study on 070830.