On Dec. 23, the U.S. Court of Appeals for the D.C. Circuit issued a decision reversing the district court’s dismissal of a civil action brought by a group of physician-owned joint ventures challenging 2008 Stark regulations that would effectively deny them reimbursement. This decision in Council for Urological Interests v. Sebelius was issued despite the general rule that all claims involving Medicare reimbursement must first go through the agency administrative process prior to judicial review in public court. The court ultimately held that under the particular facts of this case, it was not necessary for the plaintiff to first “channel” its issues through the Medicare administrative process.
The case presents a unique procedural set of facts. The court ultimately found that this particular plaintiff would be without redress through the Medicare administrative process, which is a result contrary to policy. Therefore, the plaintiff would be allowed to proceed with suit.
Factual and Procedural Background
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