Topic: Litigation

Observational Vs. Admitted: CT Advocates Win Class Status For Suit Challenging Medicare Benefits

The Center for Medicare Advocacy has won class certification for a lawsuit demanding that Medicare beneficiaries be allowed to challenge their patient classification as "observational" rather than "admitted" when hospitalized — a distinction that can cost thousands of additional dollars in hospital, medication and nursing home care.

Court Certifies Nationwide Class in “Observation Status” Case

Decision in Alexander v. Price "Observation Status" case means Medicare patients could gain the right to appeal placement on “Observation Status” and avoid large medical bills.

Wilson-Coker v. Thompson

Issue: Whether the CMS policy effected by the "Westmoreland letter" of December 3, 1999, by which home health agencies no longer are required to file claims for Medicare coverage in cases involving dually eligible beneficiaries and states are prohibited from recovering from providers which fail to submit claims, violates the Medicare and Medicaid statutes, the APA, and the due process clause.

Weichardt v. Leavitt

Issue: Whether CMS’ promulgation of final rules not requiring timely advance written notice to hospitalized Medicare beneficiaries who are being discharged violates the Administrative Procedure Act and the Due Process Clause.

Webber v. McClellan

Issue: Whether regulations issued by CMS on March 8, 2005, which, inter alia, establish a new cadre of ALJs to handle only Medicare claims and which make it virtually impossible to have an in-person hearing close to the claimant's residence (relying on telephone or videoteleconferencing hearings instead) violate the Medicare statute, (especially the Medicare Modernization Act), the Administrative Procedure Act (APA), and the Due Process Clause.

Wallis v. Thompson

Issue: Whether a National Coverage determination (NCD) which is changed should be applied to claims pending in the administrative process, even though the service was received before the change was made.

United Healthcare Insurance Co. d/b/a Evercare v. Sebelius & Starkowski

Issue: Whether the Secretary’s coverage of enteral feeding by a Part C plan on the ground that it was a skilled nursing service was correct.

UHM v. Humana, Inc. (Amicus Curiae Activity)

Issue: Whether the actions and inactions of a Medicare Part D plan, defendant Humana, in failing to enroll, and otherwise provide prescription drug coverage to, the plaintiff beneficiaries cannot be challenged under state law fraud and breach of contract causes of actions because the grievance procedures established in the Medicare Prescription Drug Improvement and Modernization Act of 2003 ("MMA") preempt those claims.

The Center for Medicare Advocacy v. U.S. Department of Health and Human Services

Issue: Whether HHS violated the Freedom of Information Act when it failed to respond to a request for documents about the videoconferencing technology to be employed in the new system for handling Medicare appeals to ALJs.

Texas Gray Panthers v. Thompson

Issue: Whether the Secretary of HHS and the Commissioner of SSA failed to implement various provisions of the Medicare statute which would require states to enroll certain low-income Medicare-eligible beneficiaries in so-called "buy-in programs" under which, depending on the program, premiums, part of premiums, and other out-of-pocket Medicare expenses would be paid for by state Medicaid programs.

Situ v. Leavitt

Issue: Whether CMS' failure to correctly implement the Part D prescription benefit for hundreds of thousands of dual eligibles violates the Medicare statute and the Due Process Clause.

Richey v. Shalala

Issue: Whether the defendant's failure to cover lung volume reduction surgery under the Medicare program violates Medicare and APA requirements.

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