Dr. Newman Case Summary

physician and patient to be performed at an ASC. Plaintiff’s Motion, p. 17, 21-22 To get to this interpretation, Dr. Newman argues that the phrase “under applicable Medicare regulations” in the definition of “outpatient surgical procedures” somehow refers to the Medicare Claims Processing Manual (which is not even a Medicare “regulation”). Specifically, Dr. Newman cites to Section 20.1 of Chapter 14 of the Medicare Processing Manual, which provides: “The ASC list of covered procedures merely indicates procedures which are covered and paid for if performed in the ASC setting. It does not require the covered surgical procedures to be performed only in ASCs. The decision regarding the most appropriate care setting for a given surgical procedure is made by the physician . . .” Id. Thus, Dr. Newman argues, “if a physician and patient determine that it is not appropriate to perform a procedure in an ambulatory surgical center,” like Bailey Square, “then that procedure is not ‘authorized’ to be performed in the ambulatory surgery center pursuant to Medicare regulations[.]” Motion at p. 21. Based on this, Dr. Newman alleges to have complied with the second prong because he performed “1005 of ASC procedures that he and the patient felt were appropriate to be …show more content…
Newman’s proposed interpretation finds no support in a plain reading of the definition of “outpatient surgical procedures.” The definition asks what procedures have been “authorized” to be performed in an ASC under applicable Medicare regulations. The definition does not ask what procedures are “authorized” to be performed at an ASC and have been approved by the physician and patient to be performed at an ASC. Indeed, the fact that Dr. Newman or his patient do “feel” that a procedure should be performed at Bailey Square has absolutely no bearing at all on whether the procedure has been authorized to be performed at an ASC pursuant to Medicare regulations. See 42 C.F.R. §§ 416.2, 416.65,