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Healthcare Partner Raja Sekaran Quoted In Law360

05/31/2018 Law360

Nossaman Healthcare Practice Group Partner, Raja Sekaran, was quoted in the Law360 article "Doc's CMS Miscoding Suit Can't Be Heard, Judge Laments."  The dispute involves the Centers for Medicare and Medicaid Services ("CMS") admittedly miscoding the practice specialty of Dr. Robert Feiss and then relying on its own mistake to deny him payment of a $40,000 incentive to provide primary care, created by the Affordable Care Act (the "ACA").  When Mr. Sekaran learned of these circumstances, he and his Nossaman colleague, Kurt Melchior, filed an action in the Court of Federal Claims on behalf of Dr. Feiss. 

At the hearing on DOJ's motion to dismiss the complaint, the Court took the government to task for its actions and encouraged it (without success) to pursue settlement with Dr. Feiss.  When later granting the motion to dismiss based on language in the ACA, Judge Loren A. Smith stated "This is not a just decision, but it is one the law requires."  In the Law360 article, Mr. Sekaran noted Judge Smith's unusual declaration of the unfairness of his own ruling, and took issue with the government for its actions, pointing out that it had a number of chances to remedy the situation with Dr. Feiss, but instead chose to "enshrine into law its freedom from review (and thereby accountability)."  An appeal is possible. 

Mr. Sekaran noted in Law360 that this is an important ruling that should be recognized by both policymakers and attorneys practicing administrative or healthcare law.  "It brings to light a law that makes agency decisions unreviewable - even when they result from the agency's admitted error and harm an individual provider who has met all of the agency's requirements and fulfilled the program's mission of bringing care to a needy population," Mr. Sekaran added.   

The full article can be read here (Paid Subscription Required).

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