Legal Challenges to MOC: Understanding Recent Lawsuits and Their Implications

Most physicians didn’t sign up for endless paperwork and recurring high-stakes tests.

But that’s what Maintenance of Certification (MOC) has become for thousands of board-certified doctors.

The promise? Lifelong learning. Quality guardrails. Public trust.

The reality? Growing controversy. Distrust. And a wave of lawsuits.

Physicians are pushing back. Legal challenges to MOC are happening everywhere. Suddenly, the courtroom is the new battleground for professional autonomy.

If you’re a doctor—or you care about how doctors stay certified—you need to know what’s happening.

Here’s what we’ll break down:

A quick MOC 101. Why doctors are frustrated enough to sue. The biggest lawsuits and what they really mean. How the courts are shaping policy. And what comes next for certification in medicine.

Let’s get into the systems, the bottlenecks, and the frameworks behind the fight.

Background: What is Maintenance of Certification (MOC)?

Most people outside medicine have no clue what MOC actually is.

Here’s the fast version:

MOC is a program that forces doctors to jump through recurring hoops to keep their board certification.

It started in the 1990s. The American Board of Medical Specialties (ABMS) and its member specialty boards built the system. Every major specialty has its own board—the American Board of Internal Medicine (ABIM), the American Board of Family Medicine (ABFM), and so on.

The stated goal? Protect the public. Keep physicians up-to-date. Build trust.

How do they do it?

Tests. Lots of them.

But that’s not all:

• Ongoing Continuing Medical Education (CME) credits
• Practice assessments and performance projects
• Regular fees (and they’re not small)

The problem is—none of these logistics come cheap. Or easy. Doctors spend thousands in fees. They lose weeks of ENERGY to test prep and paperwork.

And the kicker? Many don’t believe MOC actually improves patient care.

Surveys show a majority of physicians think MOC is irrelevant, costly, and disconnected from real-world medicine.

The bottleneck isn’t skill. It’s bureaucracy.

Physician and Organizational Frustrations with MOC: Setting the Stage for Legal Action

Here’s the truth: Most doctors don’t hate learning.

They hate pointless logistics that drain their energy and don’t help their patients—or their practice.

Surveys from the last decade show the numbers:

• Over 60% of physicians report “significant dissatisfaction” with MOC.
• Most cite time, cost, and stress as the main pain points.

The allegations get sharper:

• MOC is a money machine for the boards.
• The rules keep changing, without real transparency.
• The process is more about protecting monopoly status than patient care.

That’s not just griping. It’s turned into organized resistance.

Groups like the National Board of Physicians and Surgeons (NBPAS) and Practicing Physicians of America (PPA) are leading the charge. Their message is simple: Better systems. More autonomy. Less bottleneck.

Some want policy reform. Others are tired of waiting. They’re taking the fight to court.

Major Lawsuits Challenging MOC Requirements

Overview of Key Legal Actions

Physicians have filed lawsuits against almost every major specialty board.

The timeline? Dense.

2018–2024: A steady stream of cases lands in federal courts.

The most common legal challenges:

• Antitrust (monopoly and restraint of trade)
• “Tying” (forcing doctors to buy MOC to keep their initial board certification)
• Unfair competition
• Due process violations

Plaintiffs are often individual doctors or small physician groups. The defendants? Heavyweights like the ABIM, ABR (Radiology), ABPN (Psychiatry/Neurology), and ABFM (Family Medicine).

But the playbook is similar: Break the monopoly. End forced MOC.

Case Study: Siva v. American Board of Radiology (ABR)

Let’s get specific.

Siva v. ABR is a landmark case.

Dr. Siva—a board-certified radiologist—filed suit against the ABR. He claimed ABR illegally “tied” initial board certification to ongoing MOC purchases.

The core legal argument:

• Tying is when a company forces you to buy one product (MOC) to keep another (your original board certification).
• Siva said this was an antitrust violation—a way for ABR to lock up the market and crush competition.

ABR’s response? Certification and MOC are a single “product.” No tying. No monopoly. Everything is above board.

The first court dismissed Siva’s claim. But the appeals court reversed—at least in part.

Why? The court said Siva’s complaint was plausible enough to keep going. They didn’t buy ABR’s “single product” defense—at least not automatically.

Current status: The case is active. The outcome could reshape how boards bundle certification and MOC.

Implication: If Siva wins, specialty boards might have to separate initial certification from recertification. That’s a big deal.

Case Study: Kenney et al. v. American Board of Internal Medicine (ABIM)

Now the heavyweight: Kenney v. ABIM.

This one’s a class action. Multiple internists sued the ABIM for similar reasons—forced tying, monopolistic practices, unfair competition.

The claims:

• ABIM holds a monopoly on board certification.
• ABIM “ties” MOC to initial certification, blocking alternatives like NBPAS.
• The real advantage? Massive revenue for the ABIM. Little proven benefit for doctors or patients.

ABIM fired back: No monopoly. No illegal tying. Certification is a unified process, not two separate products.

The courts? They mostly sided with ABIM.

Key point: The court defined the market as “initial and ongoing certification”—not two distinct products. That legal framework made it nearly impossible for the plaintiffs to prove illegal tying.

Status: Dismissed. But the plaintiffs are appealing.

Broader relevance: The market definition is everything. If courts keep seeing certification and MOC as one system, lawsuits face an uphill battle.

Other Noteworthy Lawsuits

It’s not just radiologists and internists.

Psychiatrists, neurologists, and family physicians have all sued their boards:

• American Board of Psychiatry and Neurology (ABPN): Faced similar tying and antitrust lawsuits.
• American Board of Family Medicine (ABFM): Same playbook.

Most courts have dismissed these suits, usually citing the “single product” rationale.

Recurring theme: The boards are protected—so far—by how courts define the certification “market.”

But every appeal keeps the pressure on. No one’s declared victory yet.

Key Legal Arguments in MOC Lawsuits

Break it down.

The main legal arguments:

• Antitrust and Monopoly: Boards control access to certification, which is required for hospital privileges and insurance. That’s real leverage.
• Tying/Bundling: Forcing doctors to buy MOC to keep initial certification stifles competition. It blocks alternatives like NBPAS.
• Due Process: The boards change the rules, often without clear notice or appeals process.
• Financial Motivation: Critics say boards rake in millions from MOC—way beyond what’s needed for “quality assurance.”
• Impact on Competition and Access: The system keeps new entrants out, limits patient access, and reduces physician autonomy.

The bottleneck isn’t knowledge. It’s who controls the system—and how much they profit from it.

Court Decisions and Their Implications

So what have the courts actually said?

Most major rulings go like this:

• Courts say certification and MOC are one product, not two. That kills most tying claims.
• Monopoly claims are tough when the definition of the “market” is so broad.
• Courts want hard evidence of anti-competitive harm—not just high prices or physician frustration.

But not every case is a slam dunk for the boards.

The Siva case, for example, cracked open the door. At least one court said tying was “plausible,” even if not yet proven.

The real lesson?

Legal definitions are everything. “Tying” only works if courts see initial certification and MOC as separate products. So far, most don’t.

What does that mean for doctors?

Unless legal definitions change—or new evidence comes forward—boards keep their leverage. MOC requirements stay in force.

But every new case chips away at those guardrails.

Broader Impact on Certification Policy and the Medical Community

Has the legal fight changed anything?

Some. Not enough.

Boards have tweaked their systems—more flexible MOC options, lower fees, better explanations.

Alternative certification boards like NBPAS are gaining steam. Some hospitals and insurers now accept them. Not many, but enough to show cracks in the old monopoly.

Medical societies are split.

• Some push for reform and less burdensome MOC.
• Others defend the current system—arguing it’s about patient safety.

Physician advocacy is louder than ever. Litigation is only one tool. Policy reform and state medical board action are growing.

But the old guard hasn’t surrendered its advantage yet.

Future Outlook: Potential Changes to MOC and Certification Rules

What’s next?

More lawsuits. More appeals. More pressure.

Some states are considering laws to block mandatory MOC for hospital privileges or insurance panels.

Congress has held hearings. No big federal action—yet.

The smart boards are testing new models: self-assessment modules, more CME choices, even dropping high-stakes exams.

Better approach:

• Stay informed. Know your board’s policies and the court cases.
• Join advocacy groups if you want change—NBPAS, PPA, or your specialty society.
• Watch for legal appeals. A single big win could reset the guardrails for everyone.

The MOC logistics won’t vanish overnight. But the energy for reform is building.

Conclusion

The legal fight over MOC isn’t just about paperwork. It’s about who sets the rules—and who controls physician energy, time, and career growth.

Right now, the courts mostly back the boards. But the system is under fire. Every lawsuit, every advocacy push, chips away at the old advantage.

Key takeaways:

• Most courts see initial board certification and MOC as one product. That’s the main defense.
• Physician frustration is fueling new lawsuits, policy pushes, and alternative boards.
• The future? Still up for grabs. But change is in motion.

If you care about your own certification—or the next generation’s—stay engaged. Watch the legal landscape. Push for better systems.

Want more info or to get involved? Check the resources below.

Frequently Asked Questions (FAQ)

Why do some physicians support MOC while others oppose it?

Some see MOC as a way to prove ongoing competence and reassure patients. Others see it as an expensive, time-wasting bottleneck with little real-world value.

What are the risks and benefits of eliminating MOC?

Risks: Loss of a formal system for lifelong learning. Potential dip in public trust.

Benefits: More autonomy for doctors. Less wasted energy on logistics that don’t help patient care.

How can individual physicians get involved in advocacy or legal actions?

Join advocacy groups like NBPAS or Practicing Physicians of America. Attend state medical board meetings. Follow and support ongoing lawsuits. Contact your specialty society and push for reform.

What alternative certification pathways currently exist?

NBPAS is the main competitor to ABMS boards. Some hospitals and insurers now accept it. More options may emerge as legal and policy battles continue.