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Back vs. Sebelius, 9th Circuit 7/5/2012

Although it dismissed the case, the U.S. 9th Circuit Court of Appeals today also confirmed that Medicare hospice patients have the right to appeal denials of services. The defendant, Secretary of Health and Human Services Kathleen Sebelius, acknowledged after this lawsuit was filed, that Medicare hospice beneficiaries have a right to appeal coverage denials. However, the plaintiff, Howard Back could not know that, or access the appeal system, since he was told otherwise at every attempt to appeal. The 9th Circuit decision is both disappointing and hopeful. The Court has now made it clear that “… hospice beneficiaries may utilize the Secretary’s procedures to appeal a hospice provider’s refusal to provide a drug or service.” The 9th Circuit “expect[s] that the Secretary will take action to ensure her agents are properly informed in the future.” http://www.ca9.uscourts.gov/datastore/opinions/2012/07/05/11-55175.pdf

The Center for Medicare Advocacy hopes that this decision will lead to due process for Mr. Back and all other Medicare beneficiaries who are denied coverage for end-of-life care.

For more information or for comment, please contact Gil Deford, Director of Litigation for the Center for Medicare Advocacy at (860) 456-7790, gdeford@medicareadvocacy.org or visit the Center’s website at http://www.medicareadvocacy.org/

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