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A change in federal policy will make it harder for Medicare recipients to have hearings in person before a judge when the government denies claims for nursing home care, home care, prescription drugs and other treatments and services.

The Department of Health and Human Services in July will assume responsibility for the hearings. Judges will be located at just four sites around the country: Cleveland; Miami; Irvine, CA; and Arlington, VA. Previously, judges at more than 140 Social Security offices nationwide conducted hearings.

Besides a reduced number of sites, most hearings will be held using videoconference equipment or by telephone, according to Medicare officials. Only under “special or extraordinary circumstances” will beneficiaries be granted an in-person hearing before a judge, federal officials said.

The change comes as a result of the pending Medicare drug benefit, which is scheduled to take effect this January. Bush administration officials expect the benefit to generate large numbers of claims and appeals.

The government says the use of videoconference equipment will allow judges to review more cases within a mandated 90-day deadline. But opponents allege the videoconferences will reduce beneficiaries’ access to fair, favorable decisions. Sick, old and disabled people are more effective at proving their cases in person because the judge can see their infirmities, according to one group.