Open AccessCMS Asserts Broad Authority Over Physician Prescribing Practices
Author(s) -
Saner Robert J.,
Rathmell James P.
Publication year - 2015
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12672
Subject(s) - rulemaking , medicaid , patient protection and affordable care act , hindsight bias , government (linguistics) , health care , officer , medicine , law , political science , public administration , public relations , psychology , linguistics , philosophy , cognitive psychology
“Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided…”1Thus begins Title XVIII of the Social Security Act, otherwise known as Medicare, as enacted by the Congress in 1965. This “non-interference” provision represented a fundamental commitment by the Medicare programu0027s framers to both Americau0027s physicians, and to the elderly who would be served by the new Federal health insurance program. At a time when “Statesu0027 rights” were perhaps more jealously protected than they are today, it also reflected a commitment by the Congress to the States that Medicare would not usurp the Statesu0027 traditional role of licensing medical and other health professions, and overseeing their professional conduct.With the benefit of what is now almost 50 years hindsight, the provision looks almost quaint, or, more cynically, an empty promise long since negated by the Federal Governmentu0027s incursion into the regulation of medical practice. A recent rulemaking from the Centers for Medicare and Medicaid Services (“CMS”), reflects, in the view of the Pain Care Coalition and the professional societies it represents, just how far that important commitment has been eroded.In a rulemaking commenced in early January, CMS proposed to establish “improper prescribing practices” as new grounds for revoking a physicianu0027s enrollment in the Medicare program.2 (“the CMS Proposal”) The revocation of Medicare enrollment would be a fatal blow to almost any physician practice. The physician could no longer submit claims for payment of services rendered to Medicare patients, and other providers, for example, pharmacies, could no longer submit claims for items and services prescribed by the physician.While undoubtedly prompted by legitimate public health concerns about prescription drug abuse and diversion, including those …