HARTFORD, Conn. – The Center for Medicare Advocacy claims in a federal lawsuit that U.S. Secretary of Health and Human Services Kathleen Sebelius denied its clients a meaningful review of their Medicare claims during the first two levels of appeal.
The class action filed last week by four Connecticut plaintiffs alleges they can’t get a meaningful review of their cases and instead receive an initial denial of coverage. The lawsuit claims that the combined denial rate for home health care coverage at the first two levels of review is about 98 percent.
The complaint states that the denial rate for traditional Medicare has been “rapidly increasing in recent years, coinciding with the implementation of a new administrative review process for Parts A and B of Medicare.”
The new review system was supposed to be more efficient, but what it’s done is “preclude beneficiaries from obtaining an efficient and meaningful review of their claims by requiring them to take their claims to the third level of review, a hearing before an administrative law judge, if they want any realistic chance of coverage.”