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

No. 09-cv-1927-MJD-JSM (D.Minn.), filed July 23, 2009

Last Update: April 5, 2011

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.

Relief sought: Plaintiff seeks to reverse the decision of the Secretary.  Defendants (the Secretary and the state Commissioner of the Dept. of Social Services, who stands in the shoes of the beneficiary) seek to uphold that decision.

Status: A Part C plan has the right to challenge the Secretary’s final coverage decision, and in this case it did so, naming both the Secretary and the “beneficiary” (in whose shoes Commissioner Starkowski stands) as defendants, and filing it in the federal judicial district where the plan is based.  After both defendants had answered, the parties agreed to a briefing schedule. Shortly before the first brief was due, however, the MAC issued a decision favorable to the same beneficiary on a different coverage period. The plan filed a separate complaint, and, upon the parties’ agreement, the court consolidated the two cases.  The answers to the second complaint and the second administrative record were filed in early April 2010. The matter was fully briefed by the parties over the spring and summer, and oral argument was heard on October 15, 2010 in Minneapolis.

On January 7, 2011, the district court granted the defendants’ motions for summary judgment and denied the plaintiff Part C plan’s cross-motion, thereby affirming the decisions in favor of the beneficiary by the ALJ and the Medicare Appeals Council.  — F.Supp.2d —, 2011 WL 70626 (D.Minn. 2011).  The court determined that, on the facts presented, the enteral feedings were skilled services and thereby covered by Medicare.  The plan did not appeal.