Although National Federation of Independent Business v. Sebelius finally decided the most contested constitutional questions raised by the Affordable Care Act—the constitutionality of the individual responsibility requirement and of the Medicaid expansions—it by no means put an end to ACA litigation. In the wake of the June 28, 2012 decision, the courts continue to decide ACA cases and new cases continue to be filed.
A challenge to the ACA’s expanded self-referral prohibitions. On August 16, 2012, the Fifth Circuit federal court of appeals dismissed the plaintiffs’ complaint in Physician Hospitals v. Sebelius. This case had challenged the constitutionality of a provision in the ACA that extended to physician-owned hospitals the Stark self-referral prohibition, which bans Medicare payment for services ordered by a physician that has an investment or compensation arrangement with the provider that delivers the service.