ACLA hits Medicare fee schedule cuts with lawsuit

Last-minute filing seeks to delay and correct devastating new Medicare fee schedule

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This is an article from the Dec. 11, 2017 issue of THE DARK REPORT. The complete article is available for a limited time to all readers. This article plus a full analysis of 2017 developments in the PAMA process are available at all times to paid members of the Dark Intelligence Group.

medicare fee schedule lawsuit - logosIT’S A LONG-AWAITED DEVELOPMENT! Last week, a federal lawsuit was filed against the Department of Health and Human Services (HHS) by the American Clinical Laboratory Association (ACLA), seeking a delay in potentially devastating Medicare fee schedule cuts.

The lab association is asking a federal judge to review specific actions taken by the Centers for Medicare and Medicaid Services in how it is implementing sections of the Protecting Access to Medicare Act (PAMA), which will result in major cuts to the CLFS.

In its press release, ACLA stated, “The government agency that runs the Medicare program failed to follow a Congressional directive to implement a market-based laboratory payment system, thereby jeopardizing Medicare patients’ access to vital laboratory services.” The lawsuit was filed in the United States District Court for the District of Columbia.

ACLA further said, “The lawsuit asserts that CMS, operating under the purview of HHS, ignored Congressional intent and instituted a highly flawed data reporting process in advance of setting market rates under the Protecting Access to Medicare Act (PAMA). Contrary to Congress’ directives, the overwhelming majority of laboratories were prohibited from reporting private payer data. As a result, CMS failed to protect access to laboratory services for Medicare beneficiaries.”

One interesting twist in this Medicare fee schedule litigation is that ACLA is represented by an attorney who was formerly the Deputy Associate General Counsel for Litigation, CMS division of HHS. Mark D. Polston, a partner at King & Spalding, is lead counsel for ACLA.

One the four things for which ACLA seeks a judge’s ruling is this request: that the court issue an “injunction that (1) directs the Secretary to withdraw or suspend his final rule until such time as it can be brought into compliance with the statute, and (2) directs the Secretary to withhold applying the new Clinical Laboratory Fee Schedule until such time as the Secretary has made appropriate revisions to his final rule.”

Also in the lawsuit, ACLA alleged that more than 99.3% of hospitals were prohibited from reporting their market-rate data. It is believed that this is the first time this figure has been reported.

How will your lab be impacted by the Medicare fee schedule cuts if they’re implemented as scheduled on Jan. 1, 2018? Please share your thoughts with us in the comments below.


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