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Patiens and groups sue MEDICARE
Posted: Jan 20, 2011
Montpelier, VT: (AP) Five New England residents and five national health care advocacy groups filed a lawsuit Tuesday against the federal agency that administers Medicare, saying it had illegally reduced or denied benefits to thousands of patients with chronic health problems.
The lawsuit, filed in U.S. District Court in Burlington, named Health and Human Services Secretary Kathleen Sebelius as its sole defendant and took aim at an arm of Sebelius' agency, the Centers for Medicare and Medicaid Services, it charged that when clients were deemed to be making no improvements after receiving nursing, physical, occupational or speech therapy, THOSE SERVICES WERE CUT OFF.
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Medicare has always had noncovered services - just like private insurance
[ In Reply To ..]When a treatment shows no improvement, would you continue to provide? Even Medicare is not "unlimited" care when not cost effective.
The article stated that they illegally denied benefits - Backwards Typist
[ In Reply To ..]to those that showed no improvement. How and who decided there was no improvement is what I want to know. Do you know?
The doctors and/or nurses, therapists, etc. - complete care plans
[ In Reply To ..]that show assessment and plan for the patient. Like a private health insurance company for example, a diagnosis may provide three visits a week to the therapist, for 6 weeks. The health care provider has to document a reason for service, and if not, or if it unreasonable, it should not be provided.
One of the reasons I am for a universal one-payer system is that a patient may have to have one claim submitted to Medicare, another to V.A., and another to the private insurance company, and sometimes they duke it out. Would you prefer unlimited claims and services? Too much paperwork for health care personnel. I bet Canada has a much easier time with it.
Medicare and chronic illness - see message
[ In Reply To ..]Sad but true - and I'm not sure many people know this - Medicare does not provide certain benefits for chronic illness.
Example: Medicare will pay for 90 days in a skilled nursing facility. After that, you are on your own. Room and board, therapies, none of these is covered by Medicare.
It's a heartbreaking state of affairs when you have an elderly loved one who just isn't strong enough to recover in 90 days.
This is how it has always been with Medicare; it's just not widely known.
The article does not state Medicare illegaly denied benefits, rather it discusses a lawsuit challenging Medicare's denial of benefits on the basis that it is illegal.
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