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Ellen Griffith-Cohen, a CMS spokeswoman, declined to comment because the agency has a policy of not discussing pending litigation.
One former CMS official, however, said the agency has little choice but to rely on RUC to value procedures.
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A draft of the suit, which was obtained by, alleges that the Centers for Medicare & Medicaid Services (CMS) and its parent agency, the Department of Health and Human Services (DHS) violate several federal laws, including the 2010 Affordable Health Care Act, in relying on the American Medical Association/Specialty Society Relative Value Update Committee, or RUC, to value physician services paid for by Medicare. Since 1991, the RUC, which is comprised of 26 voting physician members, has proposed specific values for 7,000 medical procedures and tests and imaging values to CMS, which pays doctors based on a system called the Resource-Based Relative Value Scale (RBRVS). But since 1991, CMS has overwhelmingly rubber-stamped RUC recommendations, accepting more than 94 percent, according to AMA statistics — leading to accusations that Medicare is letting payment rates be determined in part by the very people who will receive those payments.
The workings of the RUC and the controversy over its practices were detailed in an i Watch News report last November, which is referenced in the lawsuit.
The suit also alleges that the agencies violated the 2010 Affordable Care Act by failing to establish a process to validate Medicare procedure values.
“They are getting millions of dollars of free labor.” In an email response to the lawsuit, Dr.The committee’s recommendations generally are accepted by the Centers for Medicare and Medicaid Services, the agency within the Department of Health and Human Services that manages the programs.The committee, sponsored by the American Medical Association, is known as the Specialty Society Relative Value Committee, or RUC.Today’s lawsuit, however, charges that the RUC serves as an “uncharted and unofficial federal advisory committee” to the federal government, staffed by physicians with “significant financial ties” to medical and pharmaceutical companies. Minutes or transcripts of meetings are not available to the public.By law, federal advisory committees are required to hold public meetings and keep public records of proceedings, which the RUC does not do. “Attendees at the AMA RUC meetings must sign a confidentiality agreement prohibiting them from discussing the contents of the meetings,” according to the suit, and “persons violating those confidentiality agreements have been sanctioned by the AMA.” In addition, the lawsuit charges that CMS and HHS violate the Constitution by delegating the job of developing Medicare procedure values to the RUC.