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Information about the Center for Medicare Advocacy's previous cases is listed below.

  • Action Alliance v. Leavitt October 22, 2010 No. 06-1607 (D.D.C.), filed September 15, 2006, appeal filed May 21, 2009 (No. 09-5191, D.C.Cir.)   Last Update: October 22, 2010   Issue: Whether the Secretary's refusal to inform 230,000 Part D-enrolled beneficiaries, who mistakenly were sent money reflecting the amount of their monthly premiums, of their right to request waiver of recovery, while demanding repayment by September 30, ...
  • Anderson v. Leavitt May 30, 2012No. 09-cv-16 (D.Vt.), filed January 22, 2009   Issue: Whether the Secretary's policy of terminating Medicare coverage for a home health patient on the ground that her condition is stable or is not improving violates the Medicare statute and regulations.   Relief Sought: Declaratory and permanent injunctive relief prohibiting application of the "improvement" standard, with an award of coverage to the plaintiff.   Updated: May ...
  • Back v. Sebelius October 22, 2013No. 09-1706 (C.D.Cal.), filed September 8, 2009.  Appeal filed January 28, 2011 (No. 11-55175, 9th Cir.) Issue: Whether the absence of an administrative appeals process for the denial of services by a hospice violates the Medicare statute and the Due Process Clause. Relief Sought: Declaratory and injunctive relief requiring an administrative appeals process. Updated: October 22, 2013 Status: After the ...
  • Bourgoin v. Sebelius February 21, 2014 No. 13-cv-55-JAW (D.Me.), filed February 20, 2013 Issue: Whether the Secretary of Health and Human Services violated the Administrative Procedure Act when she approved a proposed state plan amendment to Maine's Medicaid program that will allow Maine to cut back the eligibility standards in the QMB, SLMB, and QI programs  for disabled Mainers, beginning March 1, ...
  • Center for Medicare Advocacy, Inc. v. Department of Health & Human Services (No. 09-cv-672) April 5, 2011 No. 09-cv-672 (D.Conn.), filed April 24, 2009 Issue: Whether a request under the Freedom of Information Act (FOIA), 5 U.S.C. § 552, about the possible failure of Part D plans to reimburse LIS beneficiaries for premium payments for which they were not responsible, had to be answered in a timely fashion. Relief sought:  Full and timely responses to ...
  • Center for Medicare Advocacy, Inc. v. Department of Health & Human Services (No. 10-cv-645) May 30, 2012No. 10-cv-645 (D.Conn.), filed April 27, 2010 Issue: Whether a request under the Freedom of Information Act (FOIA), 5 U.S.C. § 552, about how Medicare's Improvement Standard is explained to employees of CMS and its contractors, had to be answered in a timely fashion. Relief Sought: Full and timely responses to plaintiff's FOIA request. Updated: May 30, 2012 Status: ...
  • CT DSS v. Leavitt August 25, 2006No. 399CV2020(SRU) (D.Conn.), filed October 18, 1999 Last Updated: August 25, 2006   Issue: Whether the Dept. of Health and Human Services (via CMS) violates the Medicare statute and due process clause by allowing a fiscal intermediary, United Government Services (UGS), to fail to provide written initial determinations, timely initial determinations and reconsiderations, and correct decisions to dual ...
  • Erb v. McClellan August 25, 2006No. 2:05-cv-6201 (E.D.Pa.), filed November 30, 2005 Last Update: August 25, 2006 Issue: Whether CMS' implementation of so-called "passive enrollment" into a Medicare managed care plan for over 110,000 dual eligibles in Pennsylvania, without prior notice and publication, violates the Medicare statute, (especially the Medicare Modernization Act), the Administrative Procedure Act, and the Due Process Clause. Relief sought: ...
  • Erringer v. Thompson December 15, 2010No. CIV01-112TUC-BPV (D. Ariz), filed March 16, 2001 Last Updated: December 15, 2004 Issue: Whether CMS's procedures for promulgating Local Coverage Determinations (LCDs) and for informing beneficiaries of the application of LCDs to their claims violates the APA, the Medicare statute and regulations, and the due process clause. Relief sought: Nationwide class alleged.  Declaratory and injunctive relief against ...
  • Fournier v. Leavitt July 9, 2014 No. CV 08-2309-PHX-ROS (D.Ariz.), filed December 18, 2008. Appeal filed March 6, 2012 (No. 12-15478, 9th Cir.). Issue: Whether the Secretary's exclusion of coverage for dental care in extraordinary circumstances where the care is necessary to treat a medical condition violates the Medicare statute and policy provisions, and the Equal Protection Clause. Relief Sought: Declaratory judgment that the ...
  • Garcia v. Johnson October 22, 2010No. 09-1747 (E.D.Pa.), filed April 24, 2009 Final Update: October 22, 2010 Issue: Whether the failure of the state and federal defendants to coordinate the exchange of information necessary to ensure that the beneficiaries of the Medicare Savings Program have their Medicare premiums timely paid by the Medicaid program violates the Medicare and Medicaid statutes and the ...
  • Gray Panthers Project Fund v. Thompson December 15, 2004No. 1:01CV01374(HHK)(D.D.C), filed June 22, 2001 Updated: December 15, 2004 Issue: Whether the Secretary of HHS could dispense with the statutory deadline for MCOs to submit information about their plans for the upcoming year and the Secretary could refuse to mail comparative written information about plans to beneficiaries, again as required by the statute (Click here for ...
  • Grijalva v. Shalala December 15, 2010No. CIV 93-7112 TUC ACM (D. Ariz.), filed 1993; Grijalva v. Shalala, No. 97-15877 (9th Cir.), appeal filed by defendant 1997; Shalala v. Grijalva, No. 98-1284 (S.Ct.), petition for cert. filed by defendant  Final Update: October 30, 2003 Issue: Whether the Secretary of HHS failed to ensure that HMOs provided appropriate notice and hearing rights to patients whose services ...
  • Guzzo v. Thompson(Amicus Curaie Activity) September 19, 2005No. 03-1346 (6th Cir.), appeal filed March 6, 2003 Final Update: September 19, 2005 Amicus information: Amici are the Center for Medicare Advocacy and AARP.  They are supporting the claim of the plaintiff, a Medicare beneficiary who is seeking coverage.  Amici did not participate in the district court. Issues: (1) Whether a beneficiary could only review a national ...
  • Harris v. Board of Supervisors of the County of Los Angeles December 15, 2010No. CV 03 2008FMC(PJWx) (C.D.Cal.), filed March 12, 2003  Updated: August 25, 2006 Issue: Whether the County of Los Angeles, under state law and the Medicare and Medicaid statutes, may close a rehabilitation hospital and eliminate 100 beds from another public hospital. Relief Sought: A preliminary and permanent injunction prohibiting the County from reducing the hospital services available ...
  • Hart v. U.S. Department of Social Services October 22, 2010No. 09-cv-76-CKJ (D. Ariz.), filed February 6, 2009 Last Update: October 22, 2010 Issue: Whether the defendant's failure to respond to a request for documents about the number of attorneys against whom CMS has taken action to recover conditional payments under its MSP program violates the Freedom of Information Act. Relief Sought: Declaratory and injunctive relief requiring the ...
  • Healey v. Leavitt September 21, 2007No. 398CV00418 DJS (D.Conn.), filed March 4, 1998 Last Updated: September 21, 2007 Issue: Whether the Secretary of HHS failed to ensure that home health agencies provided sufficient notice and hearing rights to home health patients whose services were cut back or terminated. Relief sought: Nationwide class alleged.  Plaintiffs sought declaratory and injunctive relief to correct the deficiencies ...
  • Landers v. Leavitt September 22, 2009No. 3:04CV1988JCH (D. Conn.), filed Nov. 23, 2004 Last Updated: September 22, 2009 Issue: Whether the Secretary's policy of not counting time in an emergency room or in "observation status" towards the three-day qualifying hospital stay for purposes of establishing the right to subsequent skilled nursing facility coverage violates the Medicare statute and guarantees of equal protection. Relief Sought: Declaratory ...
  • Lirot v. Leavitt August 26, 2006No. 3:05CV824(RNC) (D.Conn.), filed May 24, 2005 Updated: August 26, 2006 Issue: Whether the Secretary's regulation (42 C.F.R. ' 405.910(i)(1)), effective May 1, 2005, that prohibits Medicare contractors from sending copies of the notice of initial determination to the beneficiary's appointed representative violates the notice-and-comment requirements of the Administrative Procedure Act (APA) (5 U.S.C. ' 553) and ...
  • Lormore v. Shalala – Center Successfully Settles "Observation" Case April 19, 2001No. 3:00CV563(AVC), filed March 24, 2000 Updated: April 19, 2001 Issue: (1) Whether a four-day stay in a hospital can be considered “outpatient observation” status and thus preclude meeting the 3-day qualifying condition for post-hospital skilled nursing facility care; (2) whether a hospital’s refusal to submit a Part A claim, and thus to keep the plaintiff out ...
  • Machado v. Leavitt December 24, 2009No. 07-30111-MAP (D. Mass.), filed June 19, 2007 Final Update: December 24, 2009 Issue: Whether the failure of the Secretary of HHS and the Commissioner of Social Security to stop withholding premium payments for Part D when requested by beneficiaries, and to repay the amounts improperly withheld, violates the Medicare statute, the anti-assignment provision of the Social ...
  • Martinez v. Thompson December 15, 2004No. 8900-M Civil (D.N.M.) Original Case Filed In 1970, Petition To Enforce Filed May 3, 2001 Updated: December 15, 2004 Issue: Whether the failure of the Secretary, through the intermediary responsible for New Mexico, to provide a pre-deprivation hearing to a New Mexico home health beneficiary, violated a previous court order. Relief sought: Hold the Secretary in contempt, ...
  • Miles v. Leavitt January 5, 2009No. 08 CV 0432(PAC) (S.D.N.Y.), filed January 17, 2008 Updated: January 5, 2009 Issue: Whether a letter sent to state officials by CMS in August 2007, in which the agency restricted states' rights to expand eligibility in their State Children's Health Insurance Programs (SCHIP) by establishing new and onerous standards, violates the SCHIP statute (title XXI of ...
  • National Senior Citizens Law Center v. U.S. Department of Health and Human Services July 15, 2004No. 1:04CV00226 (D.D.C.), filed Feb. 12, 2004 Final Update: July 15, 2004 Issue: Whether HHS' failure to respond to a request for documents relevant to the Secretary's new policy and regulation on feeding assistants in nursing homes (see 68 Fed. Reg. 55528 (Oct. 27, 2003)) violates the Freedom of Information Act. Relief Sought:  Declare the refusal to produce ...
  • Resident Councils of Washington v. Leavitt July 30, 2004No. CV04-1691 (W.D. Wash.), filed July 30, 2004 Updated: January 3, 2008 Issue: Whether regulations that authorize states to allow Medicare and Medicaid certified nursing facilities to hire feeding assistants with eight hours of training violate the Nursing Home Reform Law or the Administrative Procedure Act. Relief sought: A declaratory judgment that the regulations are invalid and a ...
  • Richey v. Shalala May 3, 2001No. W00CA025 (W.D.Tex.), filed February 1, 2000 Updated: May 3, 2001 Issue: Whether the defendant's failure to cover lung volume reduction surgery under the Medicare program violates Medicare and APA requirements. Relief sought: Declaratory and injunctive relief regarding lung volume reduction surgery in particular and the promulgation of national coverage standards in general. Status: The court did not allow ...
  • Situ v. Leavitt May 30, 2012No. C06-02841-TEH (N.D.Cal.), filed April 26, 2006 Issue: Whether CMS' failure to correctly implement the Part D prescription benefit for hundreds of thousands of dual eligibles violates the Medicare statute and the Due Process Clause. Relief sought: A nationwide class of dual eligibles has been alleged.  Plaintiffs seek declaratory and injunctive relief to ensure that dual eligibles receive the ...
  • Texas Gray Panthers v. Thompson September 19, 2005No. 1: 99CV01557 (D.D.C.), filed June 16, 1999; In re Texas Gray Panthers, No. 01-5095 (D.C.Cir.), filed March 26, 2001. Updated: September 19, 2005 Issue: Whether the Secretary of HHS and the Commissioner of SSA failed to implement various provisions of the Medicare statute which would require states to enroll certain low-income Medicare-eligible beneficiaries in so-called "buy-in programs" ...
  • The Center for Medicare Advocacy v. U.S. Department of Health and Human Services April 9, 2009No. 1:05CV2266 (D.D.C.), filed November 23, 2005 Updated: April 9, 2009   Issue: Whether HHS violated the Freedom of Information Act when it failed to respond to a request for documents about the videoconferencing technology to be employed in the new system for handling Medicare appeals to ALJs.   Relief sought: The production of the relevant documents.   Status: HHS has produced several hundred pages ...
  • United Healthcare Insurance Co. d/b/a Evercare v. Sebelius & Starkowski April 5, 2011 No. 09-cv-1927-MJD-JSM (D.Minn.), filed July 23, 2009 Issue: Whether the Secretary’s coverage of enteral feeding by a Part C plan on the ground that it was a skilled nursing service was correct. Relief sought: Plaintiff seeks to reverse the decision of the Secretary.  Defendants (the Secretary and the state Commissioner of the Dept. of Social Services, who ...
  • Wallis v. Thompson May 3, 2005No. CIV02-448TUC(GEE)(D. Ariz.), filed September 10, 2002 Updated: May 3, 2005 Issue: Whether a National Coverage determination (NCD) which is changed should be applied to claims pending in the administrative process, even though the service was received before the change was made. Relief sought: Declaratory and injunctive relief requiring the NCD at issue (involving enhanced external counterpulsation) to ...
  • Webber v. McClellan April 5, 2007No. CV05-4219-PHX-NVW (D.Ariz.), filed December 22, 2005 Updated: April 5, 2007 Issue: Whether regulations issued by CMS on March 8, 2005, which, inter alia, establish a new cadre of ALJs to handle only Medicare claims and which make it virtually impossible to have an in-person hearing close to the claimant's residence (relying on telephone or videoteleconferencing hearings ...
  • Weichardt v. Leavitt January 3, 2008WEICHARDT v. LEAVITT No. C 03-05490 VRW (N.D.Cal.), filed December 5, 2003 Updated: January 3, 2008 Issue: Whether CMS’ promulgation of final rules not requiring timely advance written notice to hospitalized Medicare beneficiaries who are being discharged violates the Administrative Procedure Act and the Due Process Clause. Relief sought: Nationwide class is alleged. Declaratory and injunctive relief against HHS ...
  • Wilson-Coker v. Thompson October 30, 2003No. 3:00CV1312(CFD) (D.Conn.), filed July 14, 2000 Updated: October 30, 2003 Issue: Whether the CMS policy effected by the AWestmoreland letter@ of December 3, 1999, by which home health agencies no longer are required  to file claims for Medicare coverage in cases involving dually eligible beneficiaries and states are prohibited from recovering from providers which fail to ...