A proposed class action alleges the American Board of Medical Specialties and one of its member boards have abused their monopolistic hold over the board certification process to charge physicians supracompetitive prices for re-certification.
A proposed class action lawsuit out of California alleges the American Board of Orthopaedic Surgery (ABOS) and the American Board of Medical Specialties (ABMS) have abused their position within the medical community to rake in “massive, illegally obtained revenue” through anticompetitive activities.
The lawsuit explains that physicians, after becoming licensed to practice medicine in one or more states, can also obtain certifications in a specialized field of medicine from ABMS. These initial board certifications (IBC) have evolved to become “an essential component” of a physician’s practice, the case states, pointing out that over 90 percent of licensed physicians have become board-certified in at least one medical specialty.
“Fully licensed doctors authorized to practice medicine cannot expect to maintain a commercial practice, including the core requirements that they be able to maintain hospital admitting privileges, maintain malpractice insurance and, perhaps more importantly, treat a majority of the commercially insured patients in the United States, without being board certified,” the complaint asserts.
The case goes on to explain that even after becoming board-certified in a particular medical specialty, physicians must purchase from ABMS or one of its member boards, including ABOS, a “maintenance of certification” (MOC) that purportedly indicates continued learning in their field. Failure to purchase an MOC will result in a loss of certification “regardless of a physician’s skill or ability within their given specialty,” the suit says.
According to the case, the defendants have maintained a monopoly over board certification and maintenance of certification such that physicians have little choice but to pay continuously inflated prices in order to maintain certification and be able to practice in their field. The suit claims that the cost of participating in an MOC has “mushroomed 244% (or 16.3% per year) from $795 in 2000 to $1940 in 2014,” due to the absence of a competitive market.
“These costs and fees are unchecked by any meaningful competition due to defendants’ anticompetitive conduct,” the suit states, pointing out that the ABMS will not accept any competing re-certification other than its own MOC.
The case further points out that an MOC is different from state-mandated continuing medical education (CME) programs that are required in all but five states. Alongside CME, physicians have argued that MOC adds “little more than an additional burden to physicians’ time and finances.” According to the case, the defendants’ MOC is not an accurate measure of a doctor’s capability to practice in his or her field.
“Rather,” the complaint reads, “it serves as a measure of who can afford to take the test, who is a good test-taker, and who has enough time to take away from their family and practice to prepare for the re-certifications.”
The lawsuit claims physicians have been injured by the defendants’ allegedly anticompetitive conduct in that they have paid more for MOC than they would have in a competitive market.
The ABMS, and several other member boards, was previously under fire in a lawsuit filed in February 2019 that details similar antitrust allegations.