Medicare lawsuit over RUC payment advice is thrown out

A lawsuit over the formulation of Medicare rates for physician services filed by six physicians against the federal agency overseeing the program was dismissed by a district court judge in Maryland on May 9.

Doctors from the Center for Primary Care in Evans, Ga., sued the Centers for Medicare & Medicaid Services in August 2011. They claimed that CMS had violated federal law and the U.S. Constitution by using a panel of physicians’ recommendations when establishing values for Medicare services.

The American Medical Association has convened the AMA/Specialty Society Relative Value Scale Update Committee, or RUC, since 1992. The RUC has issued recommendations for relative value changes to codes used to pay for physician services, but CMS is not obligated to accept them.

The physicians had challenged the process and methodology used to calculate fees. But U.S. District Judge William M. Nickerson dismissed the allegations that CMS had violated law.

In his ruling, Nickerson referred to similar cases that had challenged relative values established for Medicare services. In one case, a judge found that physicians can review the Medicare fee schedule before electing to participate in the program each year.

Other cases, involving health professionals who had enrollments suspended or terminated, cited in support of the plaintiffs’ case were not relevant, Nickerson said. “Here, however, plaintiffs’ continued participation in the Medicare program has not been barred but is conditioned only on plaintiffs’ decision as to whether to accept fees that are offered.”

The plaintiffs are considering their options to pursue the case further, said Paul Fischer, MD, a family physician at the Center for Primary Care.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2012/05/21/gvbf0521.htm.