Top lawmaker takes aim at doctor lobby, linking AMA’s billing codes to fraud fight

STAT News – Tuesday, May 5, 2026
By John Wilkerson

For decades, politicians have blamed the country’s biggest doctor lobby for some of the health care systems problems. Now it faces a new line of attack as Republicans portray their health care cuts as fraud-fighting policies.

The law requires that doctors bill for services in Medicare and Medicaid using Current Procedural Terminology, or CPT, codes, which are owned by the American Medical Association. The codes describe what services a patient received.

A key House Republican is requesting a meeting with Centers for Medicare and Medicaid Services officials to discuss their oversight of the CPT coding system as part of his committee’s investigation into fraud, waste, and abuse. In the letter, Rep. James Comer (Ky.) suggests the “complexity” of medical coding “may be contributing to improper billing and higher costs” and “creates an environment where billing inaccuracies can flourish.”

In doing so, Comer is taking aim at an important revenue source for the AMA, as well as at one of the foundations of how American doctors and hospitals get reimbursed for care. The AMA is paid royalties for the use of the codes. More than half of the AMA’s revenue in 2024, or $301 million, came from royalties, according to its tax filing. That category also includes revenue from products unrelated to CPT codes, so it’s not possible to separate out revenue from CPT products alone.

“CPT codes, created and maintained by the American Medical Association (AMA), are the foundation of the healthcare billing system. … This maintenance structure raises concerns about federal reliance on a privately owned and licensed coding system,” Comer wrote in the letter.

The AMA said it is reviewing the letter and “looks forward to discussing the content with Chairman Comer’s office at the appropriate time.”

Lawmakers have targeted CPT codes since the early 2000s, and health secretary Robert F. Kennedy Jr.’s advisers brought the system to his attention before he was confirmed.

Those efforts, which have not meaningfully changed how the codes are set, have focused on the AMA’s “monopoly” over CPT codes, often in response to positions the AMA has taken on policies.

The late Sen. Tom Coburn, who was an Oklahoma Republican and obstetrician, accused the AMA in 2009 of supporting the Affordable Care Act to protect its medical billing code revenue. In October, Senate health committee Chair Bill Cassidy (R-La.) tied his investigation of CPT codes to the AMA’s support for gender-affirming care for minors..

Calley Means, a top Kennedy adviser, has often said the AMA promotes its own interests and those of the pharmaceutical industry to the detriment of public health. And he has specifically called out billing codes.

“The American Medical Association (AMA) is a lobbying organization funded by pharmaceutical companies,” Means posted on X a month before Trump was elected. “Why does this org have statutory authority from Congress to dictate billing codes – which establish the standards of care for American medicine?”

Comer’s allegations are a new twist. By saying that CPT codes may lead to fraud, waste, and abuse, he’s using a line of attack that Republicans previously wielded to justify withholding Medicaid funding from Minnesota and to downplay the more than $1 trillion in health care cuts in the tax bill they passed last summer.

“We’re cutting three things: waste, fraud and abuse,” President Trump said when Republicans were writing the bill that is now law. “We’re not changing Medicaid and we’re not changing Medicare.”

Comer is looking into whether the complexity of the billing system, which includes more than 7,8000 codes, enables fraud, waste, and abuse. He said hospital stays billed at the highest severity level increased almost 20%, with hospitals billing at the top severity level for 40% of all 8.7 million Medicare inpatient cases in 2019. Specifically, he’s requesting a staff-level briefing by May 7.

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