IME Research Time Revisited: Court Requires CMS to Explain Criteria


In the latest episodes of the ups and downs of the Medicare Indirect Medical

Education (IME) adjustment and the allowability of research time, the United

States District Court for the District of Rhode Island has required that CMS

explain the criteria it uses in denying reimbursement for research time that the

provider maintains was related to patient care. Rhode Island Hospital v.

Sebelius, 2009 WL 4062010 (Nov. 24, 2009). In an earlier phase of the case,

the United States Court of Appeals for the First Circuit had upheld the

Secretary's decision that research activities unrelated to patient care are not

included in the IME adjustment. This case, however, involved only the

question of reimbursement for research activities that the provider maintained

were related to patient care. Thomas W. Coons of Ober|Kaler briefly discusses the case.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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