Patients, groups sue Medicare over service cuts

[cali]

Jan 18, 2011 3:01 PM ET
By The Associated Press


MONTPELIER, Vt. (AP) — Five New England residents and five national health care advocacy groups are suing the federal government, saying Medicare benefits are being cut improperly after their conditions are determined to be chronic.

A suit filed Tuesday in U.S. District Court in Burlington on behalf of people from Vermont, Maine, Rhode Island and Connecticut targets what it calls an unofficial condition of eligibility.

That is, if a patient's condition is medically stable benefits can be reduced or the person may be found ineligible for them. The suit says the standard has never gone through an official federal rule-making process.

There's no immediate comment from the federal Department of Health and Human Services.

http://www.bloomberg.com/news/2011-01-18/patients-groups-sue-medicare-over-service-cuts.html

[customerserviceguy]

1. What ultimately could be the best possible outcome of this?

It's not going to manufacture more money for the bankrupt Medicare system, even if it succeeds. All it will do is shift resources away from somebody else who will try to find a leg to stand on when they go to sue. At worst, it simply diverts Medicare money, time, and resources to lawyers and fighting in court.

[NNN0LHI]

2. This link is light on details. Here is a better one

http://www.latimes.com/business/nationworld/wire/sns-ap-us-medicare-suit,0,1400926.story

<snip>One of the named plaintiffs, 79-year-old Edith Masterman of Wilton, Maine, has used a wheelchair since a farming accident when she was a teenager. During the past 10 years, she developed pressure sores, and her doctor ordered that she get home health care. Then her Medicare funding for her home nursing services was cut off because her condition was not improving.

She went to live in a succession of nursing homes for the 100 days that Medicare would fund.

"I found that my stay in five nursing facilities was pretty much a waste of time as I did not get the help I needed," she said. As the nursing home funding was about to run out, two physical therapists accompanied her to her home to see how she would cope, Masterman said, and "they said I would do much better in my own home where I have the necessary equipment."

She's still without Medicare-funded care for her pressure sores, but the state of Maine provides some Medicaid funding. Instead of home care, she has to head out in her wheelchair to the wound clinic at a nearby hospital, something the lawsuit said involved "taxing effort and discomfort."

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I didn't understand this until recently but Medicare only pays for nursing home stays for up to 100 days. Then the state Medicaid program kicks in. But Medicaid is means tested. Meaning if the person who is in the nursing home owns property or has other resources the state will begin legal proceedings to put a lean on that property. Not sure if that has anything to do with these cases but I wouldn't be surprised if that was an issue here.

Don