Source: http://openjurist.org/606/f2d/846
Timestamp: 2013-12-09 00:48:56
Document Index: 285572463

Matched Legal Cases: ['§ 1395', '§ 405', '§ 1395', '§ 405', '§ 405', '§ 405']

606 F. 2d 846 - Drennan v. Harris	Home606 f2d 846 drennan v. harris
606 F2d 846 Drennan v. Harris 606 F.2d 846
Stanley L. DRENNAN, M.D., Appellant,v.Patricia HARRIS (Successor to F. David Mathews), Secretaryof Health, Education and Welfare and Blue Shieldof California, Appellees.
The present controversy arose when the Los Angeles County Medical Association Medical Service Review Committee District 1 (committee) was requested by the Senate Finance Committee to review appellant's 1969 Medicare practice. Payments are to be made under Part B only for services that are reasonable and medically necessary. 42 U.S.C. §§ 1395x(v) and 1395y(a)(1). Reasonable, customary charges are determined by the carrier. 42 C.F.R. §§ 405.501-405.503. The carriers are charged with the responsibility to "take such action as may be necessary to assure that . . . such charge will be reasonable and not higher than . . . for a comparable service" and to "institute utilization safeguards which include methods for professionally assuring that payments under Part B . . . are for covered services which are medically necessary." 42 U.S.C. § 1395u(b)(3)(B); 42 C.F.R. § 405.678(a) and (c). The carrier shall "establish methods and procedures for identifying utilization patterns which deviate from medically established norms and bring such patterns to the attention of appropriate professional groups." 42 C.F.R. § 405.678(d). If the carrier concludes that a claimed service is not medically necessary, the carrier is responsible for "taking appropriate action with respect to adjustments or rejection of the claim." 42 C.F.R. § 405.678(c). Because medical issues are involved in