Court Supports HHS Clampdown on Pod Lab
A U.S. District Court dismissed a lawsuit yesterday challenging the Medicare Anti-Markup provisions in the 2008 Medicare Physician Fee Schedule rule, a landmark decision that dissolves a preliminary injunction barring implementation of the provisions and makes them immediately enforceable.
The case was brought when UroPath, LLC and three urology groups filed suit against the Department of Health and Human Services seeking an injunction to halt implementation of the provisions in the rule, which came into effect on Jan. 1, 2008.
Citing a recent Supreme Court decision and existing case law, Judge Mary M. Collyer concluded that Section 405 (h) of the Medicare Act mandates the "channeling" of virtually all legal attacks through the agency, and dismissed the case on the grounds that the federal court does not have jurisdiction in this matter.
The three urology groups and their principals would now be required to file a claim against the rule with the Secretary of HHS, and exhaust the agency's grievance process before pursuing civil action.
In addition, the judge ruled that UroPath and its medical director have no standing to challenge the anti-markup rule as they do not participate in Medicare.
The College provided to the court an amicus curie, or "friend of the court" brief, explaining why pod lab arrangements do not comply with the intent of the in-office ancillary exception to the Stark law prohibition on self-referrals.
Additionally, the brief demonstrated how pod labs can lead to over-utilization, and argues for immediate implementation of the November final rule as it relates to pathology services.
In the final ruling, the judge cited the College's amicus brief, noting that:
"The CMS final rule that is the subject of this action [i.e. the Anti-Markup Rule] is a reasonable attempt to remove from anatomic pathology the referring physician's profit motive that can corrupt medical decisions."
The anti-markup rule is now effective for anatomic pathology services if the physician group is billing for services performed in a "centralized building," and the location does not meet the definition of the "same building," as both are defined in the Stark regulations.
The College applauds the decision of the court, and will continue to advocate for changes to the in-office ancillary services exception to the Stark Law to prevent referring physicians from profiting from pathology services, regardless of whether the service is performed offsite or in-office."
Can anybody translate this into plain English?
A U.S. District Court dismissed a lawsuit yesterday challenging the Medicare Anti-Markup provisions in the 2008 Medicare Physician Fee Schedule rule, a landmark decision that dissolves a preliminary injunction barring implementation of the provisions and makes them immediately enforceable.
The case was brought when UroPath, LLC and three urology groups filed suit against the Department of Health and Human Services seeking an injunction to halt implementation of the provisions in the rule, which came into effect on Jan. 1, 2008.
Citing a recent Supreme Court decision and existing case law, Judge Mary M. Collyer concluded that Section 405 (h) of the Medicare Act mandates the "channeling" of virtually all legal attacks through the agency, and dismissed the case on the grounds that the federal court does not have jurisdiction in this matter.
The three urology groups and their principals would now be required to file a claim against the rule with the Secretary of HHS, and exhaust the agency's grievance process before pursuing civil action.
In addition, the judge ruled that UroPath and its medical director have no standing to challenge the anti-markup rule as they do not participate in Medicare.
The College provided to the court an amicus curie, or "friend of the court" brief, explaining why pod lab arrangements do not comply with the intent of the in-office ancillary exception to the Stark law prohibition on self-referrals.
Additionally, the brief demonstrated how pod labs can lead to over-utilization, and argues for immediate implementation of the November final rule as it relates to pathology services.
In the final ruling, the judge cited the College's amicus brief, noting that:
"The CMS final rule that is the subject of this action [i.e. the Anti-Markup Rule] is a reasonable attempt to remove from anatomic pathology the referring physician's profit motive that can corrupt medical decisions."
The anti-markup rule is now effective for anatomic pathology services if the physician group is billing for services performed in a "centralized building," and the location does not meet the definition of the "same building," as both are defined in the Stark regulations.
The College applauds the decision of the court, and will continue to advocate for changes to the in-office ancillary services exception to the Stark Law to prevent referring physicians from profiting from pathology services, regardless of whether the service is performed offsite or in-office."
Can anybody translate this into plain English?