CMS added blood-glucose testing criteria, suit claims

Share this content:

Nursing home plaintiffs involved in a class action lawsuit contend they have new evidence that the Centers for Medicare & Medicaid Services acted to deny coverage for blood glucose tests for diabetics residing in skilled nursing facilities.

Even though Medicare Part B covers blood glucose testing, new documents indicate the government has tried to expand the criteria to make it harder for residents to receive reimbursement. That's according to attorneys representing nursing home resident Louise Bailey and other Medicare Part B beneficiaries.
CMS has until May 1 to file an answer to the amended complaint. The lawsuit seeks declaratory and injunctive relief.
Attorneys with Reed Smith LLP, Washington, say their new evidence confirms suspicions that CMS and Part B contractor Mutual of Omaha Insurance Co. acted to restrict coverage. The evidence includes internal CMS documents that were obtained through discovery in an unrelated case, said Thomas C. Fox, a Reed Smith attorney for Bailey and others in the class.
"Our original complaint made allegations that we suspected" CMS supported the enforcement of local coverage policies by its contractors to deny coverage for blood glucose tests, Fox told the Bureau of National Affairs.
"Then we learned of the allegations in the other case and it proved what we suspected: The government is trying to find a way not to pay for the tests."