*This is an archive page. The links are no longer being updated.
1992.11.12 :  Medicare -- Result of Cosgrove V. Sullivan Federal Lawsuit

Contact:  Bob Hardy 202-690-6145                  
November 12, 1992

       The federal Health Care Financing Administration announced
today that certain Medicare beneficiaries may be eligible for
additional Medicare payments for services received during the mid-
1980s.  These additional payments result from a federal lawsuit
known as Cosgrove v. Sullivan.
       The additional payments may be owed to some beneficiaries
who received doctors' services in a hospital setting between 1984
and 1986 and for which they received payment from Medicare Part B
on an unassigned claim.  Physician services most likely to be
eligible for the additional payment were provided by
anesthesiologists, radiologists, pathologists and cardiologists. 
Beneficiaries in the following areas may be due additional
payments: California, Georgia, Montana, Nebraska, New Hampshire,
New Jersey, North Carolina, South Carolina, Utah, Vermont,
Washington, Wisconsin and Kansas City (Missouri).  Affected
beneficiaries who received services in other areas have already
been identified and paid.
       To be eligible for additional payment, the following
conditions must apply:
          1) The beneficiary must have received medical services in
          a hospital between July 1, 1984, and April 30, 1986;

       2) The beneficiary must have been partially reimbursed for
       the services by Medicare (if Medicare paid the physician
       rather than the beneficiary, then only the physician would
       be eligible for additional payment);



                         - More -- 2 -


       3) The services must have been provided in one of the
       geographical areas listed above; and

       4) The physician who provided the services must have been
       compensated by a hospital before converting, between Nov.
       1, 1982 and Jan. 31, 1985, to direct billing of patients
       (the date of conversion will typically be known only by
       the physician involved).

    To date, Medicare carriers have paid about $45 million to
affected physicians and beneficiaries.  Individual beneficiary
payments differ in amount.  The average beneficiary payment has been
approximately $10, although higher payments have been made.
    Beneficiaries who believe they may qualify for additional
payments should contact the physician who provided the services to
determine whether the physician converted to direct billing within
the applicable time period.  If so the beneficiary should call 
1-800-638-6833, (the "Cosgrove hotline"), to receive further
information about how to file a claim for additional payments, which
should be filed within 60 days.
                               

                              ###