College of American Pathologists files formal complaint with CMS about Palmetto GBA

The College of American Pathologists (CAP) has filed a formal complaint with the CMS about the recent attempts by Medicare Administrative Contractor (MAC) Palmetto GBA to tamp down pathology fraud. The complaint focuses on an educational article about appropriate utilization of ancillary stains for gastric biopsies that Palmetto posted on its website on May 30, 2014. Briefly, Palmetto, citing recent literature articles, stated ancillary stains should be performed on no more than 20% of all gastric biopsies, and should not be ordered “up front” before the H&E slide is examined. Pathologists were advised to perform a self-assessment of ancillary stain utilization, and warned pathologists who exceed the 20% level “may be subject to additional action.”

About a month after Palmetto’s article appeared, the CAP filed its formal complaint with CMS.

The formal complaint objects to Palmetto’s article for three reasons:

1. Threatening sanctions is inconsistent with the nature and purpose of an “educational” document
2. Palmetto did not go through the local coverage determination (LCD) process to arrive at its policy
3. The 20% threshold is arbitrary and could result in patient harm

CAP believes that Palmetto has exceeded its authority by imposing a pre-determined numerical utilization threshold on providers, particularly when done outside of the LCD coverage policy process, and threatening unspecified enforcement action against providers under the guise of “educational” information. CAP respectfully requests that this “educational” information either be removed from the Palmetto website or significantly modified immediately.