Physician practices and suppliers will receive payment for this practice until a trial in the related case of Atlantic Urological Associates, P.A. et al v. Leavitt or a further order from the court.
The plaintiffs in this case — three urology physician group practices that own and operate pathology laboratories; Dr. Sam Michaels, a self employed pathologist who performs testing services for other physician groups; Uropath, LLC, which manages various pathology laboratories; and Uropath?s director of clinical operations — filed against Michael Leavitt, secretary of the Department of Health and Human Services, and were able to demonstrate to the judge that “it is likely that (they) … will lose their businesses if the anti-markup rule goes into effect. The physician groups have shown that it is likely they will lose a substantial portion of their businesses and that they will be forced to close their laboratories,” according to court documents.
The judge?s injunction avoided such irreparable harm from occurring while she can further weigh the CMS provision and its implications.
CMS has argued that such markup practices allow physician groups to “realize excessive profit when billing Medicare for services … may lead to patient and program abuse in the form of overutilization of services and may result in higher costs to the Medicare program? and ?can distort medical decision-making, cause overutilization, increase costs and result in unfair competition,” according to reports.
CMS included this “anti-markup rule” as part of its final 2008 physician fee schedule for all diagnostic services, as defined in physician self-referral regulations (also referred to as the Stark Law), but postponed implementation of the rule for all of the services other than anatomic pathology.
