Appeals court strikes down oncology group's lawsuit aimed at rolling back Medicare sequestration cuts

The Community Oncology Alliance suffered another major setback in its efforts to get rid of a 2% cut to Medicare Part B payments made under the sequester. (Pixabay)

A federal appeals court has struck down the Community Oncology Alliance’s lawsuit to get rid of a 2% cut to Medicare Part B payments installed via sequestration.

The U.S. Court of Appeals for the District of Columbia issued a ruling on Tuesday that federal courts did not have jurisdiction to consider the lawsuit from the group, which represents oncology practices, that was filed in 2018.

The ruling said that the claims made by the lawsuit arise under the federal law that created the Medicare program and that federal law prohibits the district court from deciding on whether the alliance’s lawsuit had jurisdiction.

The appellate court also found that COA did not present enough information on how its members would be affected by the cuts to Medicare Part B drug payments, which went into effect with sequestration back in 2013 and extend through 2030.

Federal law does authorize district courts to review any final decision by the Department of Health and Human Services on claims under the Medicare program. But the final decision must be made after an HHS hearing.

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But the alliance doesn’t seek a review of any final decision on a claim presented to HHS.

The lawsuit notes that some members of the alliance presented “concrete reimbursement claims to [HHS],” the appellate ruling said.

“But Community Oncology identifies no such claims; it provides no claim numbers, claim amounts, agency dockets, agency findings, agency records or agency decisions of any kind,” the ruling said.

Because the alliance did not identify the claims then the court does not have any jurisdiction, the appellate panel said.

COA President Ted Okon said during a media briefing Wednesday that the alliance has no plans to appeal the ruling.

The group is among those lobbying Congress to extend a moratorium on the sequestration cuts that were installed last year to help providers struggling with fighting COVID-19. The moratorium is scheduled to expire at the end of March and COA alongside several other provider groups is asking Congress to extend it.

Okon said that it does not appear the moratorium can be included in a $1.9 trillion COVID-19 relief package that Congress is now considering. The issue is that the extension may not work as part of reconciliation, a parliamentary procedure used to get budgetary and spending bills through the Senate via a simple majority and avoid a legislative filibuster.

But there are efforts to consider a change via a back door approach, Okon said.

“We are hoping [for] a way of getting around reconciliation of helping on this sequester,” he added.