Medicare General Information, Eligibility and Entitlement Manual (Pub. 100-01), Ch. 1 § 60.4
Statutory Obligations of Practitioners and Other Persons
60.4 - Statutory Obligations of Practitioners and Other Persons
(Rev. 1, 09-11-02)
It is the obligation of any health care practitioner or other person who furnishes or orders health
care items or services that may be reimbursed under Medicare, to ensure that to the extent of his
or her authority, those services are:
•
Furnished economically and only when and to the extent medically necessary;
•
Of a quality that meets professionally recognized standards of health care; and
•
Supported by evidence of the medical necessity and quality of the services in the form
and fashion that the reviewing PRO may reasonably require (including copies of the
necessary documentation) to ensure that the practitioner or other person is meeting the
obligations imposed by Section 1156(a) of the Act.
These obligations apply whether payment is made directly to the provider (i.e., assignment) or to
the beneficiary, or even if payment is not made.