Lawsuit Challenges Unjust and Inefficient Medicare Appeals Process

On June 5, 2014 The Center for Medicare Advocacy filed a complaint in the United States District Court in Connecticut against Kathleen Sibelius, Secretary of Health and Human Services.  The lawsuit was filed on behalf of plaintiffs who have been denied meaningful review of their Medicare claims at the first two levels of appeal.  This is a class action case, and the four named plaintiffs who represent thousands of Medicare beneficiaries in Connecticut who cannot obtain a meaningful reviews of their cases.

According to the lawsuit complaint home health claims at the first two levels of appeal have a 98% denial rate.  It alleges that Redetermination and Reconsideration levels, the first two levels of Medicare Appeals, are essentially a “rubber Stamp” to deny the claims of the Medicare Beneficiaries.  Only appeals that reach the Administrative Law Judge provides a meaningful evaluation of their Medicare claims.  The complaint also alleges this problem persist throughout the country.

In one of our previous email alerts we provided information about the American Hospital Association Suing HHS of timely hearings at the ALJ level.  Providers, suppliers and Medicare Beneficiaries could have to wait three to five years at the ALJ level.  The National Association of Home Care also recently filed a lawsuit on Face-to-Face Encounter.  Maybe the things are beginning turn around for the health care industry.  We support and encourage all of our clients, subscribers and friends to support all of the lawsuits.

For more information please use the following link:

 http://www.medicareadvocacy.org/lawsuit-challenges-unjust-and-inefficient-medicare-appeals-process/