GAO Finds That Medicare Coverage Varies Greatly by Geographical Area

February 1, 1995

WASHINGTON--In testimony before the House Small Business Subcommittee chaired by Rep. Ron Wyden (D-Ore), the US General Accounting Office (GAO) said that Medicare beneficiaries may be denied reimbursement for certain x-rays and other diagnostic tests, depending on where they live.

WASHINGTON--In testimony before the House Small Business Subcommitteechaired by Rep. Ron Wyden (D-Ore), the US General Accounting Office(GAO) said that Medicare beneficiaries may be denied reimbursementfor certain x-rays and other diagnostic tests, depending on wherethey live.

For example, a patient living in Illinois is 1,400 times morelikely to be denied payment for blood tests on the grounds thatthey are not medically necessary than one living in northern California.In addition, that Illinois patient is 900 times more likely tobe denied reimbursement for a chest x-ray than one living in Wisconsin.

Rep. Wyden called for a more logical system of determiningMedicare reimbursement guidelines. He called the Health Care FinancingAdministration (HCFA)'s current practice a "crazy quilt of separate and dramatically different rules."

Medicare payments for physician services are determined by34 insurance companies under contract to HCFA. They sort, evaluate,and pay medical bills, guided by their own policies, not by auniform rule established by the federal government.