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Healthcare Providers Who Provide Cash-Only Services Must “Opt-Out” of Medicare To Avoid Being Charged With Fraud – Amazing Story

gavelThe American Psychological Association (APA) Insurance Trust recently released an article/advisory that ALL healthcare providers need to read, regardless if you accept Medicare or not. This amazing story details how a private pay (only) psychologist landed himself in a legal and financial nightmare with Medicare. I find these developments to be extremely frustrating as a future clinician that intends to offer self-pay psychological services to avoid these type of legal scenarios that seem to plague healthcare providers who accept private or government health insurance. There is apparently no escape from our horrendously litigious and complex healthcare system – even if you choose not to participate.

This APA article provides important guidelines for clinicians who offer cash or insurance based services. In short, psychologists (or other healthcare providers) who offer self-pay services to persons over 65 need to “opt-out” of Medicare. I know – why do you have to opt-out of something you never “opted-into?” In addition, practices that accept cash-only must provide specific legal contracts to patients over 65 else face fraud charges and a forced refund of all monies collected after the patient turned 65. Recommendations for practitioners who accept Medicare are also detailed. Here is excerpt from this APA article:

“Dr. Tripper called Medicare and was told that a licensed psychologist cannot provide self-pay services to a Medicare-eligible patient unless the psychologist has “opted out” of his or her provider status in compliance with national Medicare regulations. Dr. Tripper noted that he has never been a Medicare provider, that he does not recall “opting in” and thus he assumed he must be “opted out.” The Medicare representative informed Dr. Tripper that, because he was not a Medicare provider, the client’s money must be returned and the patient cannot be charged for any future services. Further, the matter will be turned over to the Medicare fraud unit.”

Please visit the website for this important article here:


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