Frier Levitt partner Guillermo Beades is featured in a Part B News article, “Can You Force Patients to Get an AWV? Not Without Risk” by Roy Edroso, helping answer a complex question. The question posed in the article states, “I’m a patient of a local primary care practice that recently sent me a letter saying they are “required by CMS to perform and submit annual wellness exam information on each Medicare/Medicare Advantage patient each year. Although CMS does not penalize the member when the AWV information is not submitted annually, your PCP/Provider is reported as being non-compliant with patient care, which does affect our standing and reimbursement with CMS.” For that reason, the letter went on, “our office requires that all patients with Medicare/Medicare Advantage coverage undergo an AWV annually to continue to retain [the practice] as their Primary Care Physician (PCP).” Can they do that?”
Guillermo, along with other industry professionals, shares his legal knowledge to provide some clarity on this topic. Notably, in some cases, the law can require certain services be provided. Guillermo points to Supreme Court case law, specifically the 1905 case Jacobson v. Massachusetts, which upheld a state’s authority to require inoculation if there is sufficient public interest for it. This finding was seen again more recently in COVID-era vaccine mandate rulings (PBN 10/17/22). However, it is unlikely that any court would find comparable public interest justifying a requirement for the AWV.