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Cardiology Takes Legal Action Against Medicare
Date:12/29/2009

Complaint filed against HHS Secretary to Preserve Patient Access to Cardiology Care

WASHINGTON, Dec. 29 /PRNewswire-USNewswire/ -- The American College of Cardiology (ACC) today announced that it filed a complaint against the Department of Health and Human Services (HHS) Secretary Kathleen Sebelius in United States District Court. The complaint alleges that Secretary Sebelius, in her capacity as the HHS Secretary, unlawfully adopted the payment rates for cardiology services in the 2010 Medicare Physician Fee Schedule (PFS) by using an invalid Physician Practice Information Survey (PPIS) in a manner that threatens access to care for patients and precipitously increases medical care costs.

The complaint alleges that Secretary Sebelius and the Centers for Medicare and Medicaid Services (CMS) abused their discretion and acted arbitrarily and capriciously in violation of the Medicare statute and the Administrative Procedures Act by using the invalid PPIS in adopting the payment rates for cardiology services in the PFS. According to the complaint, clear and critical defects exist with respect to the methodology and data used to develop the PPIS, which was used to justify the cuts to Medicare reimbursement rates for cardiology, and which directly undermine the viability of community practices. These include, among other flaws, CMS' decision to use information from only 55 cardiologists to set reimbursement under Medicare for all of the cardiologists in the entire nation, when the results from that very small group were widely different from more reliable information that was available.

The ACC filed this lawsuit today with the hope of enjoining the implementation of the PFS for cardiology based on this flawed survey data, and to require CMS to use more reliable, available data or conduct a new survey to determine a new 2010 PFS for cardiology services performed consistent with the law.

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SOURCE American College of Cardiology
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