Litigation Archive

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, 2012
  No. 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, 2013
  No. 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, ...
• Bremby v. Burwell October 13, 2016
  No. 3:15-cv-01397 (DJS), filed September 22, 2015 Issue: Whether the Secretary violated the Medicare statute and the Due Process Clause by not recognizing that Vitamin B-12 injections represent a per se skilled nursing service and therefore the service should have been covered, and, in general, by failing to recognize the right to coverage for per se skilled ...
• 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, 2012
  No. 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, 2006
  No. 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, 2006
  No. 2:05-cv-6201 (E.D.Pa.), filed November 30, 2005 Last Update: August 25, 2006Issue: 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, 2010
  No. 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, 2010
  No. 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, 2004
  No. 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, 2010
  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  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, 2005
  No. 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 ...
• Haro v. Johnson October 13, 2016
  No. 09-cv-134-TUC-DCB (D.Ariz.), filed March 10, 2009.  Appeal filed June 30, 2011 (No. 11-16606, 9th Cir.). Issue: Whether the Secretary’s aggressive methods for attempting to collect payments under his Medicare Secondary Payer (MSP) program, directed at beneficiaries and their attorneys, violates the Medicare statute and the Due Process Clause. Relief sought: Declaratory and injunctive relief prohibiting defendant’s ...
• Harris v. Board of Supervisors of the County of Los Angeles December 15, 2010
  No. 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, 2010
  No. 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, 2007
  No. 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 ...
• Hull v. Sebelius October 13, 2016
  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 ...
• Jimmo v. Burwell November 12, 2014
  No. 5:14-cv-128 (D.Vt.), filed June 23, 2014 Issue: Whether the denial of coverage for named plaintiff Glenda Jimmo by the Medicare Appeals Council on re-review of her claim under the revised manual provisions pursuant to the Jimmo settlement agreement was correct. Relief Sought: Reversal of the Secretary’s decision denying coverage and granting the claim for coverage. Updated: November ...
• Landers v. Leavitt September 22, 2009
  No. 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 ...
• Lessler v. Burwell October 13, 2016
  No. 3:14-cv-01230 (D.Conn.), filed August 26, 2014 Issue: Whether the consistent failure of administrative law judges (ALJs) to issue decisions within 90 days of the request for ALJ review (with an average delay now approaching 500 days) violates the Medicare statute and the Due Process Clause. Relief sought: Declaratory and injunctive relief prohibiting the Secretary from not ensuring ...
• Lirot v. Leavitt August 26, 2006
  No. 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 ...
• Lodge v. Burwell October 13, 2016
  No. 3:15-cv-00390-JBA (D.Conn.), filed March 17, 2015 Issue: Whether extraordinary dental care should be covered because the exclusion for coverage of dental care should be limited to routine dental care. Relief Sought: Reversal of the Secretary’s decision denying coverage to the plaintiff and enjoining the Secretary from relying on a regulation that does not define the coverage ...
• Lormore v. Shalala – Center Successfully Settles "Observation" Case April 19, 2001
  No. 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, 2009
  No. 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, 2004
  No. 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, 2009
  No. 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, 2004
  No. 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 ...
• Olsen-Ecker v. Burwell October 13, 2016
  No. 3:15-cv-1468-JAM, filed October 9, 2015 Issue: Whether the extremely high denial rates (98% and higher) at the redetermination and reconsideration stages of administrative review for home health care claims violate the Medicare statute and the Due Process Clause.  Relief sought: Declaratory and injunctive relief requiring the Secretary to correct the existing system of lower level review ...
• Prendergast v. Leavitt November 12, 2014
  No. 3:08-CV-1148 (AHN) (D.Conn.), filed July 31, 2008 Issue: Whether the use of a "stability" test to terminate home health coverage on the ground that the patient no longer needs skilled nursing care violates the Medicare statute and regulations. Relief Sought: Declaratory judgment, and temporary and permanent injunctive relief on behalf of an individual Medicare beneficiary. Final Update: ...
• Resident Councils of Washington v. Leavitt July 30, 2004
  No. 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, 2001
  No. 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 ...
• Ryan v. Burwell October 13, 2016
  No. 5:14-cv-269 (D.Vt.), filed Dec. 19, 2014 Issue: Whether the failure of the Secretary to apply the “prior favorable homebound decision” rule, which accords “great weight” to previous administrative decisions establishing homebound status, violates the Medicare regulations, as implemented by the Medicare Program Integrity Manual, and the Due Process Clause. Relief Sought: Declaratory and injunctive relief on ...
• Situ v. Leavitt May 30, 2012
  No. 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, 2005
  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. 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, 2009
  No. 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 ...
• UHM v. Humana, Inc.(Amicus Curiae Activity) October 22, 2010
  No. 06-35672 (9th Cir.), case in progress for several yearsUpdated: October 22, 2009   Issue: Whether the actions and inactions of a Medicare Part D plan, defendant Humana, in failing to enroll, and otherwise provide prescription drug coverage to, the plaintiff beneficiaries cannot be challenged under state law fraud and breach of contract causes of actions because the grievance ...
• 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, 2005
  No. 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, 2007
  No. 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, 2008
  WEICHARDT 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, 2003
  No. 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 ...