Medicare review challenges receive class action certification

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Six Medicare beneficiaries whose appeal cases were delayed beyond 90 days will have their challenges tried as one nationwide class action suit.

A federal judge in Connecticut granted class certification to the beneficiaries, saying a national class was appropriate because the plaintiffs met the required factors for class certification, and because the claims involved a nationwide program. The judge also rejected the government's argument that the plaintiffs' claims were invalid, since they all suddenly received hearings and decisions at the administrative law judge level shortly after their complaints were filed.

The beneficiaries, the majority of whom live in Connecticut and are represented by the Center for Medicare Advocacy, filed Medicare coverage claims for acute care that were denied by the U.S. Department of Health and Human Services. After submitting requests for their appeals to be heard by an ALJ, the beneficiaries waited to receive decisions for periods ranging from 194 to 626 days—well beyond the 90-day waiting period. One plaintiff, who appealed for coverage of a nursing home stay in November 2013, died one day before his decision was received in September 2014.

The Center for Medicare Advocacy noted beneficiaries and providers are waiting too long on reviews. In similar cases brought by medical providers around ALJ delays, the judges have granted the government's motions to dismiss.

“Even though Medicare has recently been sending beneficiaries to the front of the ALJ line so that they do not have to wait as long as providers – though still well beyond the mandated 90 days – we have to remember that Medicare is all about beneficiaries,” said Judith Stein, executive director for the Center for Medicare Advocacy.