The Medicare Advocacy Project of Greater Boston Legal Services recently received a favorable decision from the U.S. District Court in Massachusetts for “off-label” coverage of the drug Dronabinol. This is a welcome development given … [Read more...] about Federal Court Issues Favorable Off-label Part D Drug Coverage Decision
Litigation
Smith v. Burwell
No. 14-1519 (APM) (D.D.C.), filed Sept. 5, 2014 Amicus information: Amici are the Center and the National Health Law Program. They are supporting the claim of Medicare beneficiaries that they should be covered for a form of testing that … [Read more...] about Smith v. Burwell
Jimmo v. Burwell
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 … [Read more...] about Jimmo v. Burwell
Prendergast v. Leavitt
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 … [Read more...] about Prendergast v. Leavitt
Fournier v. Leavitt
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 … [Read more...] about Fournier v. Leavitt
Bourgoin v. Sebelius
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 … [Read more...] about Bourgoin v. Sebelius
Back v. Sebelius
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 … [Read more...] about Back v. Sebelius
Jimmo v. Sebelius Improvement Standard Case Summary
Attorneys from the Center for Medicare Advocacy, Vermont Legal Aid and the Centers for Medicare & Medicaid Services (CMS) have agreed to settle the "Improvement Standard" case, Jimmo v. Sebelius, No. 11-cv-17 (D.VT), filed January 18, 2011. … [Read more...] about Jimmo v. Sebelius Improvement Standard Case Summary
Settlement Reached to End Medicare’s “Improvement Standard”
Attorneys from the Center for Medicare Advocacy, Vermont Legal Aid and the Centers for Medicare & Medicaid Services (CMS) have agreed to settle the "Improvement Standard" case, Jimmo v. Sebelius.[1] A proposed settlement agreement[2] … [Read more...] about Settlement Reached to End Medicare’s “Improvement Standard”
Situ v. Leavitt
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 … [Read more...] about Situ v. Leavitt