Application of Exclusion to Nongovernmental Providers,

50.3.2 - Application of Exclusion to Nongovernmental Providers, Physicians and Suppliers (Rev. 1, 10-01-03) A3-3153.3.B, HO-260.3.D, B3-2309.4 Payment may not be made for items or services furnished by a nongovernmental provider, physician or supplier if the charges have been paid for by a government program other than Medicare, or if the provider, physician, or supplier intends to look to another government program for payment, unless the payment by the other program is limited to the Medicare deductible and coinsurance amounts, as it is for certain individuals covered under TRICARE/CHAMPVA. (See §50.4). The mere fact that a nongovernmental provider receives government financing does not mean that the items and services it furnishes are considered paid for by a governmental entity. However, if a clinic receives government financing earmarked for particular services to patients (e.g., in the form of a research grant), Medicare may not pay for the same services. If an individual has the option of receiving care free of charge at a government provider or care which is not free at a nongovernment provider, and the individual, chooses the latter, Medicare payment may be made for the care at the nongovernment provider. However, items and services authorized by a Federal agency (for example, by the VA at a nongovernmental hospital) are excluded. (See §50.3.3, below.)