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ALJ/MAC Decision Database


 

LITIGATION ARCHIVES
 

  • The Center for Medicare Advocacy v. U.S. Department of Health and Human Services
    No. 1:05CV2266 (D.D.C.), filed November 23, 2005

    At issue in this case is 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.
    Updated: April 9, 2009
     

  • CT DSS v. Leavitt
    No. 399CV2020(SRU) (D. Conn.), filed October 18, 1999


    At issue in this case is whether the Department of Health and Human Services (via the Centers for Medicare and Medicaid Services) 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 beneficiaries in Connecticut receiving home health care.
    Last Update: August 25, 2006
     

  • Erb v. McClellan
    No. 2:05-cv-6201 (E.D.Pa.), filed November 30, 2005

    At issue in this case is w
    hether 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.
    Last Update: August 25, 2006
     

  • Erringer v. Thompson
    No. CIV01-112TUC-BPV (D. Ariz.), filed March 16, 2001

    At issue in this case is whether the Centers for Medicare and Medicaid Service'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.
    Last Update: December 15, 2004
     

  • Gray Panthers Project Fund v. Thompson
    No. 1:01CV01374(HHK)(D.D.C.), filed June 22, 2000

    At issue in this case is whether the Secretary of Health and Human Services 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.  
    Last Update: December 15, 2004
     

  • Grijalva v. Shalala
    No. 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


    At issue in this case is whether the Secretary of HHS failed to ensure that HMOs provided appropriate notice and hearing rights to patients whose services were cut back or terminated.
    Last Update: October 30, 2005
     

  • Guzzo v. Thompson - Amicus Curaie Activity
    No. 03-1346 (6th Cir.), appeal filed March 6, 2003


    At issue in this case are whether a beneficiary could only review a national coverage determination (NCD) based on evidence available at the time that it was adopted, as opposed to at the time of the beneficiary's claim, and whether an NCD that was changed while the beneficiary's administrative claim was pending (but after the surgery had been performed) should be applied retroactively to authorize Medicare coverage.
    Last Update: July 15, 2004
     

  • Harris v. Board of Supervisors of the County of Los Angeles
    No. CV 03 2008FMC(PJWx) (C.D.Cal.), filed March 12, 2003


    At issue in this case is 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.
    Last Update: August 25, 2006
     

  • Hart v. U.S. Department of Health and Human Services

    No. 09-cv-76-CKJ (D. Ariz.), filed February 6, 2009

     

    At issue in this case is 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.

    Last Update: October 22, 2010
     

  • Healey v. Leavitt
    No. 398CV00418 DJS (D.Conn.), filed March 4, 1998


    At issue in this case is whether the Secretary of Health and Human Services failed to ensure that home health agencies provided sufficient notice and hearing rights to home health patients whose services were cut back or terminated.
    Last Update: September 21, 2007
     

  • Landers v. Leavitt
    No. 3:04CV1988JCH (D. Conn.), filed Nov. 23, 2004

    At issue in this case is whether the Secretary's policy of not counting time in an emergency room or in "observation status" toward 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.
    Last Update: September 22, 2009
     

  • Lirot v. Leavitt
    No. 3:05CV824(RNC) (D.Conn.), filed May 24, 2005


    At issue in this case is whether the Secretary=s regulation, 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) and the Medicare statute, was promulgated arbitrarily and capriciously in violation of another provision of the APA, and violates the Due Process Clause.
    Last Update: August 25, 2006
     

  • Lormore v. Shalala
    No. 3:00CV563(AVC), filed March 24, 2000


    At issue in this case were: (1) whether a four-day stay in a hospital can be considered Aoutpatient 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 of the administrative process, violates the Medicare statute and regulations; and (3) whether the notices provided by the hospital were sufficient.
    Last Update: April 19, 2001

  • Machado v. Leavitt
    No. 07-30111-MAP (D. Mass.), filed June 19, 2007

    At issue in this case is w
    hether 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 Security Act, and the Due Process Clause.
    Last Update: December 24, 2009
     

  • Martinez v. Thompson
    No. 8900-M Civil (D.N.M.) Original Case Filed In 1970, Petition To Enforce Filed May 3, 2001

    At issue in this case is whether the failure of the Secretary of Health and Human Services, 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.
    Last Update: December 15, 2004
     

  • Miles v. Leavitt
    No. 08 CV 0432(PAC) (S.D.N.Y.), filed January 17, 2008

    At issue in this case is 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 the Social Security Act) and the Administrative Procedure Act (APA), 5 USC 553 and 706.
    Updated: January 5, 2009
     

  • National Senior Citizens Law Center v. U.S. Department of Health and Human Services
    No. 1:04CV00226 (D.D.C.), filed Feb. 12, 2004


    At issue in this case is whether the Department of Health and Human Services must produce documents pursuant to the Freedom of Information Act on the Secretary's new feeding assistant policy and regulation that took effect in October 2003.
    Final Update: July 15, 2004
     

  • Resident Councils of Washington v. Leavitt
    No. CV04-1691 (W.D. Wash.), filed July 30, 2004


    At issue in this case is the legality of regulations issued in 2003 that permit states to allows nursing facilities to employ feeding assistants with only eight hours of training.
    Last Update: January 3, 2008
     

  • Richey v. Shalala
    No. W00CA025 (W.D.Tex.), filed February 1, 2000


    At issue in this case was whether the defendant=s failure to cover lung volume reduction surgery under the Medicare program violates Medicare and APA requirements.
    Last Update: May 3, 2001
     

  • Texas Gray Panthers v. Thompson
    No. 1: 99CV01557 (D.D.C.), filed June 16, 1999;
    In re Texas Gray Panthers, No. 01-5095 (D.C.Cir.), filed March 26, 2001.


    At issue in this case is whether the Secretary of Health and Human Services and the Commissioner of the Social Security Agency 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" under which, depending on the program, premiums, part of premiums, and other out-of-pocket Medicare expenses would be paid for by state Medicaid programs.
    Last Update: September 19, 2005
     

  • Wallis v. Thompson
    No. CIV02-448TUC(GEE)(D. Ariz.), filed September 10, 2002


    At issue in this case is 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.
    Last Update: May 3, 2005
     

  • Webber v. McClellan
    No. CV05-4219-PHX-NVW (D.Ariz.), filed December 22, 2005

    At issue in this case is 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 instead) violate the Medicare statute, especially the Medicare Modernization Act, the Administrative Procedure Act (APA), and the Due Process Clause.
    Last Update: April 5, 2007
     

  • Weichardt v. Leavitt
    No. C 03-05490 VRW (N.D.Cal.), filed December 5, 2003


    At issue is 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.
    Last Update: January 3, 2008
     

  • Wilson-Coker v. Thompson
    No. 3:00CV1312(CFD) (D.Conn.), filed July 14, 2000


    At issue in this case was whether the CMS policy effected by the "Westmoreland 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 submit claims, violates the Medicare and Medicaid statutes, the APA, and the due process clause.
    Last Update: October 30, 2003

 
 


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