The ABIM MOC lawsuit landscape includes three major federal cases: Kenney v. ABIM, a class-action antitrust suit dismissed in 2019 and affirmed on appeal in 2021; AAPS v. ABIM, which added First Amendment claims and was dismissed with prejudice in July 2025 after a partial revival by the Fifth Circuit; and a December 2025 suit brought by the American Osteopathic Association in Illinois, which remains active. Courts have so far sided with the American Board of Internal Medicine, holding that initial certification and Maintenance of Certification are a single product rather than two products that can be illegally tied together.
Kenney v. ABIM: The Class-Action Antitrust Case
On December 6, 2018, four internists — Gerard Kenney, Alexa Joshua, Glen Dela Cruz Manalo, and Katherine Murray-Leisure — filed a class action in the U.S. District Court for the Eastern District of Pennsylvania on behalf of more than 100,000 internal medicine physicians.1Medical Economics. Docs Sue Board of Internal Medicine Over MOC They were represented by the firm Robinson Curley.2ABIMLawsuit.com. Kenney v. ABIM Case Filings
The complaint alleged that ABIM illegally tied its initial board certification to the purchase of MOC exams, creating a monopoly that let it charge inflated prices. Plaintiffs pointed to ABIM’s alleged efforts to thwart the National Board of Physicians and Surgeons, an alternative certification body, as evidence of anticompetitive conduct.3Medscape. Internists File Class-Action Antitrust Suit Against ABIM Alongside Sherman Act antitrust claims, the suit brought federal RICO and state unjust enrichment claims and sought damages and an injunction.4Robinson Curley. Kenney v. ABIM
Dismissal and Third Circuit Affirmance
On September 26, 2019, Judge Robert F. Kelly dismissed the lawsuit in its entirety. The court found that initial certification and MOC were not two separate products in distinct markets but components of a single product: ABIM certification status. “We disagree with the Plaintiffs and find that ABIM’s initial certification and MOC products are part of a single product and do not occupy distinct markets,” the court wrote. “Not only are we unconvinced by Plaintiffs’ arguments, we find that Plaintiffs’ entire framing of the ABIM certification to be flawed.”5ABIM Blog. ABIM Statement Regarding Dismissal of Antitrust Lawsuit The class was never certified.6Fierce Healthcare. Doctors Lose Legal Battle Against MOC Recertification Requirements
The plaintiffs appealed. On February 25, 2021, the Third Circuit affirmed on all counts, agreeing that the plaintiffs had not plausibly alleged initial certification and MOC are separate products, which defeated both the tying and monopoly claims. The court also found the RICO allegations insufficiently specific and observed that some plaintiffs had chosen not to participate in MOC, undercutting the claim that they were forced to buy it.7FindLaw. Kenney v. American Board of Internal Medicine
AAPS v. ABIM: Antitrust and First Amendment Claims
The Association of American Physicians and Surgeons Educational Foundation filed a separate lawsuit in the Southern District of Texas, layering First Amendment and due process claims onto antitrust arguments. AAPS alleged that ABIM’s threats of decertification chilled physician speech and that the board functioned as a state actor because hospitals and insurers effectively enforced its requirements.8KevinMD. The ABIM MOC Lawsuit: What Physicians Need to Know
A district court dismissed the case in 2022. On June 3, 2024, the Fifth Circuit partially revived it in a decision by Judges King, Ho, and Engelhardt. The panel found AAPS had standing on a “right to hear” theory, reversed dismissal of the First Amendment claims, and vacated dismissal of the antitrust claims. It also struck down a local court rule that had blocked AAPS from amending its complaint, leaving the state-actor question for the district court on remand.9FindLaw. AAPS v. American Board of Internal Medicine
The July 2025 Dismissal With Prejudice
On remand, ABIM again moved to dismiss. On July 31, 2025, Judge Jeffrey Vincent Brown dismissed all claims against ABIM and the American Board of Obstetrics and Gynecology with prejudice. The court held that AAPS had not plausibly alleged the boards are state actors, which defeated the First Amendment and due process claims. It dismissed the antitrust claims for lack of standing, ruling that alleged censorship of physician speech is not a recognized antitrust injury. Tortious interference and defamation claims also fell for failure to allege specific unlawful acts or false statements.10U.S. District Court for the Southern District of Texas. AAPS v. ABIM, Memorandum Opinion and Order
AOA v. ABIM: The Active Osteopathic Case
On December 3, 2025, the American Osteopathic Association and the American College of Osteopathic Internists, joined by six individual physicians, sued ABIM in the Northern District of Illinois. Unlike the earlier cases, this one targets a specific ABIM policy rather than MOC as a whole: the requirement that residency and fellowship program directors hold ABIM certification. The rule bars physicians certified by the American Osteopathic Board of Internal Medicine from attesting to the training of residents and fellows who plan to sit for ABIM board exams.11American Osteopathic Association. ABIM Lawsuit
The AOA alleges that because ABIM certifies roughly 95% of internal medicine physicians, the policy effectively locks osteopathic physicians out of program director positions and steers trainees toward ABIM certification. Several plaintiff physicians reported career setbacks, including demotions, loss of directorships, or having to obtain redundant certifications to keep their leadership roles. The AOA calls the suit a “last resort” after failed collaborative efforts and says its antitrust claims cover conduct occurring after the resolution of a prior dispute.12Medical Economics. ABIM Monopoly Hurts Osteopathic Physicians Overseeing Residency, Fellowship Programs, Lawsuit Says The case remains active as of mid-2026.11American Osteopathic Association. ABIM Lawsuit
Why Physicians Sued
Board certification in internal medicine is not legally required to practice, but hospitals routinely require it for admitting privileges, malpractice insurers factor it into coverage, and health plans use it for network credentialing.8KevinMD. The ABIM MOC Lawsuit: What Physicians Need to Know ABIM is the sole organization that certifies internists in the United States, and once a physician earns initial certification, ABIM requires ongoing MOC participation to maintain it.
MOC requires an annual fee of $220 for the first certificate and $120 for each additional one, 100 MOC points every five years, and a periodic knowledge assessment.13ABIM. MOC Fees Physicians who take the traditional ten-year exam pay an additional $700 registration fee. A 2018 analysis cited in the Kenney lawsuit estimated ten-year compliance costs at an average of $23,607 in money and time for internists, reaching $40,495 for some specialists.3Medscape. Internists File Class-Action Antitrust Suit Against ABIM
ABIM has always maintained that MOC is voluntary. Former board chair David H. Johnson noted that “board certification has sufficient credibility and public acceptance that many hospitals, health systems and patients use it to help decide with whom they want to work.”14ABIM. Physicians Enroll in the ABIM MOC Program in Record Numbers Plaintiffs argued that the voluntary label is meaningless when hospitals and insurers treat certification as a prerequisite, leaving opt-outs facing what one filing called “professional exclusion.”8KevinMD. The ABIM MOC Lawsuit: What Physicians Need to Know
Changes ABIM Has Made Alongside the Litigation
ABIM has made incremental reforms during the same period the lawsuits have moved through the courts. In February 2015, the board acknowledged it had “clearly got it wrong” and announced a two-year suspension of the practice assessment, patient voice, and patient safety requirements, froze fees at 2014 levels through 2017, and changed public reporting language from “meeting MOC requirements” to “participating in MOC.”15American Medical Association. MOC Requirements Modified for Internal Medicine Physicians The practice assessment suspension became permanent in 2017.16Healio. ABIM MOC Program Adapts, Faces New Challenges and Success
In 2022, ABIM introduced the Longitudinal Knowledge Assessment, which lets physicians take shorter, open-book tests remotely on a rolling basis rather than sit for a single eight-hour proctored exam every ten years. About 80% of physicians now choose the LKA over the traditional exam.16Healio. ABIM MOC Program Adapts, Faces New Challenges and Success In October 2024, ABIM eliminated the two-year MOC point check-in requirement, restoring “Certified, Participating in MOC” status to roughly 12,000 physicians who had fallen behind on the biennial deadline.17ABIM. Physicians Spoke and ABIM Listened: Two-Year MOC Point Requirement Is Eliminated The five-year, 100-point cycle remains in place.
State Laws and the NBPAS Alternative
The fight has moved most successfully outside federal court. The National Board of Physicians and Surgeons, founded in 2015 by cardiologist Paul Teirstein and 20 other physician leaders, offers a competing certification that requires a valid medical license, 50 hours of continuing medical education every two years, and prior ABMS board certification. NBPAS reports over 15,000 certified physicians and recognition by more than 250 hospitals, health systems, and payers, along with accreditation from the National Committee for Quality Assurance, the Utilization Review Accreditation Commission, and The Joint Commission.18NBPAS. About Us Its fees run roughly 72% less than ABIM’s program, by one estimate.19TCTMD. Cardiologists’ Anger Flares Anew Over ABIM Maintenance of Certification
More than a dozen states have passed laws limiting MOC’s role in credentialing. A 2019 Connecticut legislative analysis identified comprehensive prohibitions in Arkansas, Georgia, Oklahoma, South Carolina, Tennessee, and Texas, where state licensing boards, insurance providers, and hospitals are barred from requiring MOC.20Connecticut General Assembly. Anti-MOC State Legislation Report Kentucky and Maryland have enacted narrower laws focused on licensing boards.21Urology Times. States Attempt to Limit Importance of MOC Tennessee’s 2018 law, passed unanimously in both chambers, prohibits insurers from excluding physicians from networks based solely on MOC status and gives hospital medical staffs discretion to accept alternative competency measures.22Memphis Medical Society. Tennessee Legislature Approves Physician-Friendly MOC Bill
The federal courts have so far held that private certification organizations have the right to set and modify their own standards, and that initial certification and MOC together form a single product.23Credentialing Insights. Court Decisions Reject Challenges to MOC Requirements, Support Standard Setting The AOA’s Illinois case is the only federal challenge still live as of mid-2026, and the broader question of ABIM’s market power continues to be litigated primarily in statehouses.