The Center for Medicare Advocacy and co-counsel, the National Senior Citizen Law Center, filed a class action lawsuit earlier this year against Kathleen Sebelius, the Secretary of Health and Human Services, on behalf of seven individual plaintiffs who represent a nationwide class of individuals harmed by an increasingly common practice.
The plaintiffs are Medicare beneficiaries who received inpatient hospital services, but were improperly classified as outpatients, often referred to as “observation status,” and therefore deprived of Medicare Part A coverage for their hospital stay and after care.
The misapplication of “observation status” deprives Medicare beneficiaries of their coverage rights and may cause them to absorb significant hospital costs that otherwise would be paid for under Medicare Part A.
“We’ve turned to the courts for fairness because ‘observation status’ harms thousands of Americans receiving Medicare each year, nationwide,” said Judith Stein, Founder and Executive Director of the Center for Medicare Advocacy, one of the nation’s leading legal advocates for the more than 48 million older and disabled Americans enrolled in Medicare. “It causes severe financial problems for beneficiaries and their families, and deprives them of nursing home coverage altogether.”
“Throughout my sister’s hospital records the word ‘admitted’ or ‘admit’ was used. So we were shocked when we were advised that she was ‘observation only,’” stated Mrs. Shirley Burton, a plaintiff seeking justice for her late sister, Nettie Jean Sapp, of Temple Texas.
Plaintiff Lee Barrows of Connecticut described her husband’s five-day stay in a Connecticut hospital as an observation patient and denial of Medicare payment for his subsequent nursing care. “After five days of treatment in the hospital, my husband’s neurologist, physician and social worker ushered me into the hallway to tell me that my husband was never admitted. I was stunned with disbelief and tearfully blurted out that I would fight this,” said Mrs. Barrows. “His doctors then indicated that this happens once or twice a week.”
The judge’s ruling has not yet been issued.
An attorney from the Center for Medicare Advocacy will be at the Bristol Senior Center on Nov. 6 at 1:30 p.m. to discuss the issue.