Doctors Sue HHS, CMS Over 'Secretive' Payment Committee

John Commins, August 11, 2011

Six primary care physicians from Georgia have filed a lawsuit against the federal government, claiming that a committee of volunteer physician-advisors that recommends reimbursement rates for Medicare procedures and services is secretive and skewed toward medical specialists.

The physicians, all from the Center for Primary Care in Evans, GA complain that for nearly 20 years the Department of Health and Human Services and the Centers for Medicare and Medicaid Services have relied on the "specialist-dominated" Relative Value Scale Update Committee (RUC) for reimbursement advice.

The 74-page suit, filed this week in U.S. District Court in Maryland, claims that the RUC violates the Federal Advisory Committee Act's requirements for representation, transparency, and methodological rigor. As a result, the Center for Primary Care physicians claim, the RUC "has systematically overvalued many specialty procedures while undervaluing primary care." The plaintiffs want a federal judge to suspend the RUC process until HHS and CMS comply with FACA rules.

One of the plaintiffs, Paul Fischer, MD, told HealthLeaders Media that the timing of the suit is "very fortuitous," as Congress grapples for ways to contain Medicare costs.   

"We are going to win this. The law is pretty clear and the facts are pretty clear. We will win on a legal basis," Fischer says. "But the second thing is Medicare is too expensive and so broken and the government doesn't have too many things it can do. This gives the government a tool."

John Commins

John Commins is a senior editor at HealthLeaders Media.

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