No. 14-801 (D.Conn.), filed June 4, 2014
Issue: Whether the Secretary of Health & Human Services’ denial rate of about 98% at the lowest two levels of appeal in Medicare’s system of administrative review (redetermination and reconsideration) violates the Medicare statute and the Due Process Clause.
Relief sought: Declaratory and injunctive relief for a Connecticut class of Medicare beneficiaries who have received or will receive adverse redetermination and reconsideration decisions on their claims for coverage of home health care services.
Updated: October 13, 2016
Status: The complaint (here) and a motion for class certification with a supporting memorandum were filed on June 4, 2014. The Secretary filed a motion to dismiss instead of an answer, claiming that plaintiffs lacked standing and had failed to exhaust administrative remedies. On December 8, 2014, after the class motion was fully briefed (but not argued) and discovery responses were being provided, the court granted the motion to dismiss. Hull v. Burwell, 68 F. Supp. 3d 278 (D.Conn. 2014). The court held that the named plaintiffs lacked standing because, as dual beneficiaries with Medicaid coverage, they were not deprived of services nor did they suffer any financial harm. The court rejected the argument, which had been accepted by several other courts, that the deprivation of Medicare coverage itself was a sufficient injury to confer standing. Plaintiffs filed a motion for reconsideration, but that was denied on July 6, 2015.
Plaintiffs appealed, but moved to hold the appeal in abeyance, which was granted, in light of a case pending in the Supreme Court that raises a similar standing issue. After the decision in that case came down (see Spokeo, Inc. v. Robins, 136 S.Ct. 1540 (2016)), plaintiffs’ counsel decided not to proceed with the appeal. They moved to dismiss it, which was done on June 7, 2016, ending the case.