AAPS Asks Court to Stall Restrictions on Medicare Patients’ Tests and Referrals

American Academy of Physicians & Surgeons ^ | March 13, 2013 | staff

[grumpygresh]

If allowed to go into effect, a March 1 notice from HHS (the Department of Health and Human Services) will eliminate Medicare payments for tests and referrals ordered by physicians not enrolled in the Medicare program, as of May 1.

"Because of Medicare's increasingly costly and restrictive rules placed on doctors, many Medicare-eligible patients are receiving medical care from physicians not enrolled in the program," states Jane M. Orient, M.D., executive director of the Association of American Physicians and Surgeons (AAPS). "This looming change by HHS will deprive the patients of benefits for blood tests, x-rays, and specialist consultations—benefits for which they were forced to pay all their working lives, and which would be covered if ordered or referred by a Medicare-enrolled physician."

AAPS filed an emergency motion for injunctive relief today in the U.S. Court of Appeals for the District of Columbia Circuit.

The benefit cut results from changes to Medicare's Provider Enrollment, Chain and Ownership System (PECOS). HHS has additional authority in this area of Medicare as a result of the Patient Protection and Affordable Care Act (PPACA or "ObamaCare"), and AAPS's challenge to PECOS is part of its lawsuit against PPACA.

AAPS filed suit against PPACA three days after it was signed into law, but the case was stayed pending a Supreme Court decision in the case brought by the National Federation of Independent Business (NFIB) and 26 states.

In upholding ObamaCare as outside Congress's power to regulate but within its power to tax, the Supreme Court acknowledged that "any tax must still comply with other requirements in the Constitution." The motion filed by AAPS is the first to ask an appellate court to rule on whether PPACA violated the Origination Clause of the U.S. Constitution, which requires that all "bills for raising revenue" originate in the House of Representatives.

The Founders fought for independence largely because of excessive taxation without representation. As a result, when they drafted the Constitution, they insisted that taxes originate in the House, the legislative body closest to the People, both in representation and in election cycles.

ObamaCare originated in Senator Reid's 2000-page amendment to a 6-page House bill about tax credits for members of the armed forces who are called into overseas assignments. AAPS has raised several arguments why ObamaCare constitutes an illegal tax, including violation of the Origination Clause.

AAPS is represented by Lawrence Joseph of Washington, D.C.

AAPS is a national organization representing physicians in all specialties. AAPS was founded in 1943.

[grumpygresh]

The Feds really want to quash private health care. A private non-Medicare physician ordering a test or procedure (covered by Medicare, and conducted by a Medicare contracted provider) is simply making a recommendation based on his/her knowledge and experience. The government is, in effect, impeding care and discriminating against the patient, for using a non Medicare physician.

[NonValueAdded]

The RATs are constantly scaring the carp out of seniors telling them all the horrible things the Republicans are going to do to Medicare (and SocSec). Yet look at all they have done, Obama in particular, to the program. And we hear not a peep. And I don’t mean from the MSM who acts as expected. I mean from the Republicans.

[svcw]

Restrictions on medicare are already in effect....

[asinclair]

And why are so many primary-care physicians not enrolled in the program? It's that "cost-cutting" that does nothing to reduce one of the biggest expenses for a doctor, malpractice insurance. They lawyers say "do these tests to cover your ass in case you are sued" and Medicare says "don't do those tests, they cost too much and aren't in the patients' best interest."

Not to mention the harassment some doctors have reported regarding their Medicare claims. The whole system encourages cheating in the interests of "reducing medical costs" -- and those costs are being reduced on the back of the doctors. If the harassment were restricted to the fraudsters, I'd cheer.

My own doctors have renounced Medicare, including my cardiologist.

[Buckeye McFrog]

Massachusetts is about the yank the license of any physician who does not participate. Look for other blue states to follow suit, followed by the Feds eventually.

[grumpygresh]

“My own doctors have renounced Medicare, including my cardiologist.”

I have done similar. Although I am still enrolled in Medicare as a provider. I have released my old Medicare patients, and will not take new ones. The reason is the criminalization of medical coding.