Brian Stimson Files Amicus Brief Supporting CMS Medicare Payment Rule

AGG Healthcare practice co-chair Brian Stimson, together with co-counsel Craig F. Simon from Meadows, Collier, Reed, Cousins, Crouch & Ungerman LLP, filed an amicus brief in The CAMPs Initiative v. U.S. Department of Health and Human Services, pending before the U.S. District Court for the Northern District of Texas. AGG Healthcare of counsel James Ritter-Wiseman and Litigation & Dispute Resolution attorney Nikita Kulkarni assisted in the preparation and filing of the amicus brief.

The brief was submitted on behalf of value-based care organizations, including accountable care organizations (“ACOs”), companies that support the delivery of value-based care, and physicians and providers participating in these models. The amici support the government’s motion to dismiss a lawsuit challenging a Centers for Medicare & Medicaid Services (“CMS”) rule that modifies how certain skin substitute products are reimbursed under Medicare Part B.

The CMS rule was adopted following rapid growth in Medicare spending on skin substitute products used to treat chronic wounds. In the litigation, the plaintiff seeks to invalidate the rule and restore the prior payment framework. The amicus brief explains how the earlier reimbursement structure created incentives that contributed to escalating Medicare expenditures and imposed financial pressures on value-based care organizations responsible for managing overall patient costs.

The brief argues that CMS acted within its statutory authority in adopting the rule and that the agency engaged in reasoned decision-making to address concerns related to fraud, waste, and abuse in the Medicare program. The brief also highlights how payment reform can complement enforcement efforts and support the broader goals of improving quality and controlling costs within Medicare.

If you have questions about the lawsuit or about these issues in general, please contact Brian, James, or Nikita.