00-2518 American Society of Cataract and Refractive Surgery, et al. v. Thompson, et al.

Listen to this article

“We agree with the district court’s determination that the Medicare Act, by its express terms, precludes judicial re view of the determination of relative values and relative value units, including review of the regulation promulgated by the Secretary implementing a statutory transition formula for the determination of PE-RVUs. Title 42 of the United States Code section 1395w-4(i)(1) expressly provides that: ‘there shall be no administrative or judicial review under section 1395ff of this title or otherwise of-… (B) the determination of relative values and relative value units under subsection (c) of this section. …’ (emphasis added) (‘paragraph (B)’). We find this provision to be a clear and explicit indication of Congress’s intent to prohibit administrative and judicial review of the Secretary’s decision now challenged by petitioners.

“Additionally, the payment scheme in Part B of the Medicare Act supports our determination that Congress intended to bar judicial review of petitioners’ challenge. RVUs are used to calculate the physician’s fee schedule. The fee schedule is updated yearly and each year’s schedule is established by November 1 of the preceding year. See 42 U.S.C. sec. 1395w-4(b)(1). As respondents highlight, this tight time frame demands that the Secretary’s decisions regarding the RVUs be made quickly and efficiently. Further, Congress directed that adjustments in the RVU component of the fee schedule be made in a budget neutral fashion, see 42 U.S.C. sec.sec. 1395w- 4(c)(2)(B)(ii), (c)(2)(F), 1395w-4 note, requiring increases for some services to be offset by decreases in others. While petitioners acknowledge that a favorable decision would be disruptive, we believe, as respondents persuade us to, that to ensure finality so that the Secretary can make any necessary budget neutrality adjustments, claims such as petitioners’ claim must be precluded from judicial review.”

Affirmed.

Appeal from the United States District Court for the Northern District of Illinois, Eastern Division, Williams, J., Kanne, J.