Good morning, ProviderNation.
The legal eagles at AHCA/NCAL are soaring into a potential class-action suit challenging federal observation stay rules. Here’s the background: 14 Medicare patients sued the government alleging that their due process rights were violated when they were put on observation status. Last September, a federal District Court in Connecticut dismissed the case, saying that a previous decision by the 2nd Circuit Court of Appeals means that when Kathleen Sibelius uses a word, it means just what she chooses it to mean—neither more nor less.
The plaintiffs here are appealing their dismissal (back with their old friends in the 2nd Circuit). The plaintiffs are arguing that the feds should be required to give written notice when they’re placed on observation status, what it will cost, and whether they can challenge the status. The plaintiffs are also arguing that they should have the right to appeal observation status administratively under the Medicare statute.
In an Amicus brief filed to the circuit, AHCA lawyer Mark G. Arnold says that the current rules are expensive and dangerous for Medicare patients.
“The private interest here is clear: the ability to obtain necessary, often life-saving, medical treatment in a timely fashion,” Arnold says in the brief. “Of at least equal importance is the prospect that the absence of full Medicare benefits prevents the beneficiary from obtaining necessary medical care at all. One of the named plaintiffs … had to depart from the [skilled nursing center] despite her need for such services because she could not afford its costs.”
Given that the 2nd Circuit has already ruled on the matter the odds against the plaintiffs seem long. But, after all, one only gets what one negotiates for.