It is not possible to estimate the impact of the REMS (on EBITDA) as it relates to prescribing patterns, until the REMS is in effect which is expected to be some time in 2009 or early 2010. We believe a possible impact of the REMS could be further reductions in ESA utilization.
On July 1, 2009, CMS proposed changes to policies and payment rates for services to be furnished under the 2010 physician fee schedule. Under the proposed provisions, EBITDA would be reduced by approximately $23 million. However, we currently estimate the impact to 2010 EBITDA of actual changes to CMS policies and payment rates will be between $5-$10 million. The most significant difference between the potential and estimated impact reflects our expectation that Congress, as in previous years, will enact legislation to avert a 21.5% Sustainable Growth Rate reduction. The final rule is expected to be issued on or around November 1, 2009.
As previously disclosed, during the fourth quarter of 2005, we received a subpoena from the United States Department of Justice's Civil Litigation Division ("DOJ") requesting a broad range of information about us and our business, generally in relation to our contracts and relationships with pharmaceutical manufacturers. Also, as previously disclosed, the Company is currently involved in litigation with a formerly affiliated practice in Oklahoma. In addition, as previously disclosed, the Company and an affiliated practice have received a request for information from the Federal Trade Commission and a state Attorney General relating to an antitrust investigation of a recent transaction in which a group of physicians joined the affiliated practice. There were no material developments in these matters during the second quarter of 2009 or through the date of this release.
On July 29, 2009 the Company received a subpoena from the U.S. Attorney's Office, Eastern Dist
|SOURCE US Oncology, Inc.|
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