Audiologists Sue to Challenge Medicare Laws That Unfairly Lock Them In and Shut Patients Out
Frankfort, Ky. -- The Academy of Doctors of Audiology (ADA) and two ADA members, Jill Davis, Au.D. of Austin, Texas and Alicia Spoor, Au.D. of Highland, Maryland, have filed a federal lawsuit challenging the law that prohibits audiologists from opting out of Medicare and contracting privately with Medicare beneficiaries. Audiologists should be treated equally to physicians, dentists, optometrists, nurse practitioners, psychologists, dietitians, and other providers who already have that right under the law. The Pacific Legal Foundation, a nonprofit public-interest law firm, is representing the plaintiffs at no cost. Academy of Doctors of Audiology et al. v Kennedy was filed in the United States District Court for the Western District of Texas, Austin Division.
The plaintiffs assert that exclusion of audiologists from Medicare’s opt-out provisions violates the Fifth Amendment’s guarantees of equal protection and due process and exceeds Congress’s power under the Commerce Clause.
Plaintiffs are asking the court to order the federal government to stop enforcing laws that prohibit audiologists from privately contracting with Medicare beneficiaries and to require that audiologists be permitted to opt out of Medicare and contract privately with Medicare beneficiaries on the same terms as eligible physicians and practitioners.
“Medicare laws unfairly hold audiologists and their Medicare patients captive in a broken system of care,” said Stephanie Czuhajewski, MPH, Executive Director of the Academy of Doctors of Audiology. “The ability to enter into a private contract for services, and the right to refuse to enter into a bad contract are among our nation’s most basic freedoms. The government has already extended these rights to most Medicare providers. ADA simply seeks equal treatment and parity for audiologists under the law, so that audiologists and Medicare beneficiaries have the same rights, freedoms, and agency that other healthcare providers and patients already enjoy.”
Medicare locks audiologists into a system that undermines efficient, evidence-based care delivery and often locks patients out of audiology services altogether.
- Medicare rules unfairly limit beneficiary access to audiologists—rules that do not apply when care is delivered by physicians or hearing aid dispensers, who directly compete with audiologists for patients. Medicare beneficiaries must obtain a physician order in most circumstances to seek care from an Audiologist. An order is not required to seek similar services from other providers.
- Medicare reimburses audiologists between $29 – $40 for a diagnostic hearing assessment. The cost of filing, monitoring, and adjudicating each claim can cost the practice as much as $13. Yet, audiologists are responsible for determining medical necessity and must defend every clinical decision against risk of claim denial, civil penalties, and prosecution.
- Medicare relegates audiology services to “other diagnostic services.” Therefore, Medicare-covered treatment services such as vestibular rehabilitation, aural rehabilitation, and cerumen removal are not covered if they are delivered by a licensed, qualified audiologist. Medicare Part B patients must contract privately for these services if they choose to receive them from an audiologist. Medicare reimburses other, often lesser-trained, providers for delivering the exact same services.
- Hearing aids and hearing aid-related services are statutorily excluded from Medicare coverage altogether. Medicare Part B patients must already contract privately for these services.
For the past 15 years ADA has sought federal legislative and regulatory Medicare reforms to improve access and coverage of Medicare audiology services. This lawsuit does not replace but rather supplements that work by petitioning the judicial branch for just relief for audiologists, and by extension, their Medicare patients. ADA will continue its relentless advocacy efforts with all three branches of government as is consistent with its mission to advance evidence-based clinical and business practices in the delivery of hearing and balance services and the autonomous practice of audiology in all clinical settings.
Importantly, this suit, Academy of Doctors of Audiology et al. v Kennedy does not change Medicare requirements for how audiologists must see or bill Medicare and Medicare patients today. Audiologists are advised to keep following all current Medicare rules while the case is pending.
About the Academy of Doctors of Audiology
The Academy of Doctors of Audiology promotes evidence-based clinical and business practices in the delivery of hearing and balance care and the autonomous practice of audiology in every clinical setting. For more information visit www.audiologist.org.
About Pacific Legal Foundation
The Pacific Legal Foundation is a public interest law firm that defends Americans’ liberties when threatened by government overreach and abuse. Read the Pacific Legal Foundation press release. Visit www.pacificlegal.org for more information.