June 2000 Bulletin

Court dismisses lawsuit to review formula for practice expense RVUs

A federal district court has dismissed a lawsuit filed by 11 medical societies, including AAOS, seeking judicial review of the formula used to determine practice expense relative value units for 1999 through 2001.

The lawsuit disputed the decision of the Secretary of the Department of Health and Human Services’ (HHS) and Administrator of the Health Care Financing Administration to use 1998 as the base year for determining payment in the transition years to the new Medicare physician payment system.

The U.S. District Court for the Northern District of Illinois ruled that "because the express language of the statute (the Medicare Act) bars judicial review and the overall structure of the Medicare Part B Payment scheme supports this conclusion, this court finds congressional intent to foreclose judicial review of the Secretary’s instructions and regulations." The court also ruled that the challenge to HHS policy "is substantive and not collateral and there is no federal jurisdiction to hear this claim."

The lawsuit was filed by the American Society of Cataract and Refractive Surgery; AAOS; American Academy of Dermatology; American College of Cardiology; American Gastroenterological Association; American Association of Neurological Surgeons; Congress for Excellence in Eyecare, Inc; Outpatient Ophthalmic Surgery Society; American Society of Gastrointestinal Endoscopy; American College of Gastroenterology; and American Society of General Surgery.

Some medical societies may appeal the ruling, but the AAOS has not made a decision to join an appeal, said William W. Tipton Jr., MD, AAOS Executive Vice President.


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