Friday, May 28, 2021

Very Brief Blog: ACLA Files New Appeal in Ongoing 2017 PAMA Case

ACLA's case against CMS's implementation of PAMA lab pricing law enters another round.   In a press release on May 28, 2021, ACLA announced that it was responding to another setback, on March 31, in federal court, by filing an appeal.

See the ACLA press release here.  See an updated FAQ here.

And if you want to really delve into the situation, see the litigation timeline here (with numerous document links.). See the most recent March 2021 dismissal, PDF, 11pp, here.

Originally, ACLA protested CMS's implementation of PAMA, focusing on under-counting of hospitals and their lab test prices.  In the first round at District Court, case was denied since the CMS lab fee schedules are outside judicial review.  Federal Court determined that the case could and should be reviewed, and remanded back to the same district court.   Now, after 18 months, District Court has re-reviewed it, but dismissed as "moot."  

District Court notes that CMS revised its regulations in 2018, to include far more hospital labs and claims.  Therefore, the judge surmises, the only live issue is whether the 2016-2017 price setting was wrong, resulting in under-pricing 2018-2021, with the potential for enhanced payments (restitution) for these recent past years.   HHS argues that no refunds or bonus payments would be possible, and therefore no material event remains at issue in the case (it is all moot).   The judge concurred that it could not order new payments for past years, but in the new documents, ACLA strenuously disagrees.