Payment may not be made for items or services furnished by a non-governmental provider
where the charges have been paid for by a government program other than Medicare,
or where the provider intends to look to another government program for payment, unless
the payment by the other program is limited to the Medicare deductible and coinsurance
The fact that a nongovernmental provider receives government financing does not mean
that the items and services it furnishes are paid for by a government 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.
Where an individual has the option of receiving free care at a government provider
or care which is not free at a non-government provider, and he chooses the latter,
Medicare payment may be made for the care at a non-government provider. However, items
and services authorized by a Federal agency (for example, by the VA at a nongovernmental
hospital) are excluded.