AMA Charged with Abusing Monopoly on CPT Code Fees

• A patient group has filed a lawsuit against the AMA, alleging that it is abusing its government-backed monopoly by charging excessive fees for using CPT codes.
• The AMA has been collecting these fees from healthcare providers and organizations, which are then passed on to patients in the form of higher medical bills.
• The lawsuit claims that the AMA's actions constitute an abuse of its market power and a violation of antitrust laws.

The AMA has been charging for CPT codes since 1992, when it began licensing the code set to healthcare providers and organizations.

A patient group has filed a lawsuit against the American Medical Association (AMA), alleging that the organization is abusing its government-backed monopoly by charging excessive fees for using the Current Procedural Terminology (CPT) code set. The AMA has been collecting these fees from healthcare providers and organizations, which are then passed on to patients in the form of higher medical bills. This practice has sparked controversy, with some arguing that it is an unfair burden on patients who already struggle to afford medical care.

The lawsuit, filed in a federal court, claims that the AMA's actions constitute an abuse of its market power and a violation of antitrust laws. The patient group is seeking damages and an injunction to stop the AMA from collecting these fees.

The AMA has been charging for CPT codes since 1992, when it began licensing the code set to healthcare providers and organizations. In recent years, the organization has increased its fees significantly, with some reports suggesting that the cost of using the CPT code set can be as high as $10 per code. This has led to concerns about the impact on patients who are already struggling to afford medical care.

The lawsuit filed by the patient group is not the first challenge to the AMA's CPT code fees. In 2022, Senator Bill Cassidy sent a public letter to the AMA accusing it of abusing its government-backed monopoly and charging exorbitant fees for using the CPT code set.

The lawsuit against the AMA has significant implications for the US healthcare industry. If the patient group is successful in its claims, it could lead to a re-evaluation of the AMA's charging practices and potentially result in lower costs for patients. Additionally, the case highlights the need for greater transparency and accountability in the way that healthcare organizations operate.

The AMA's CPT code fees are just one aspect of a broader debate about the role of medical associations in setting industry standards and collecting fees from healthcare providers. As the lawsuit makes clear, these practices can have significant consequences for patients and should be subject to greater scrutiny.

Lawyers and compliance officers should watch for potential antitrust implications of the AMA's charging practices, which could impact their clients' business models or regulatory compliance strategies.

Source: Original reporting via Above the Law