Physicians File Suit Against CMS

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A group of primary care physicians from Georgia have filed suit against the Centers for Medicare and Medicaid Services (CMS) in the United States District Court for the District of Maryland, claiming that the agency and the Department of Health and Human Services (HHS) are violating federal laws by relying on the American Medical Association/Specialty Society Relative Value Scale Update Committee, or RUC to set the Medicare physician payment schedule.

The physicians allege that CMS and HHS are failing to comply with the Federal Advisory Committee Act (FACA), the Administrative Procedure Act (APA), the Patient Protection and Affordable Care Act (PPACA), the Mandamus Act, the Delegation Clause of the United States Constitution, and the Due Process Clause of the Fifth Amendment to the United States Constitution.

The group also aims to stop CMS and HHS from setting the Medicare physician schedule using RUC advice, Moreover, they seek declaratory judgments, including that CMS and HHS unlawfully use and rely on RUC in setting the physician fee schedule; that the agencies fail to ensure that their actions are not an abuse of discretion; and that CMS and HHS are violating the Constitution by handing over their authority to set Medicare procedure to RUC.

Congressman Jim McDermott (D-WA), who is also a physician, earlier this year introduced a bill that would require CMS to include input from “neutral, third-party analysts.” “Over the past 20 years, we have watched the RUC distort Medicare’s, and therefore the whole country’s, physician payment system,” McDermott says in a statement in response to the Georgia doctors’ lawsuit. “When Congress changed Medicare’s physician-payment system in 1992, it wanted to put primary care on an equal footing with specialty care – not only to improve the quality of care, but also to bring down our crushing national healthcare costs. Regrettably, because CMS relies so heavily on the specialist-driven RUC, the opposite has taken place.”

Brian Cook, CMS’ media director, says the agency does not comment on pending litigation. However, according to the Center for Public Integrity’s iWatchNews, an anonymous former CMS official claims CMS relies on RUC because it does not possess sufficient financial resources to replace the free services it receives from that entity.