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Medicare Sued Over Failure to Set Up Appeals Process

  • August 8th, 2002

Three Medicare beneficiaries are suing the Bush administration because they were denied coverage for treatment of a disease that causes blindness. The suit charges that the administration has violated federal law by failing to put in place a process mandated by Congress two years ago that would allow Medicare beneficiaries to appeal coverage decisions.

The three beneficiaries suffer from age-related macular degeneration, the leading cause of blindness in people aged 50 and over. The only effective treatment for the disease is a drug called Visudyne. Last October the Centers for Medicare & Medicaid (CMS) announced that Medicare would cover the drug for beneficiaries, but this past March CMS reversed its decision, saying the treatment is "experimental" and only "temporarily" effective.

When the three plaintiffs tried to appeal the March reversal, they received word from CMS that their appeals would not be processed. This, they claim in the suit, violates a law passed by Congress in December 2000 that required CMS to create an appeals process for national coverage decisions. Congress mandated that the appeals process be in place by October 2001. Nearly a year later, CMS has still not established an appeals process.

The American Council for the Blind, the American Association of People with Disabilities and the Gray Panthers, an advocacy group for the elderly, are also plaintiffs in the case.

To search for and retrieve read an article on the lawsuit from the Baltimore Sun''s online archive, click here.

To read the press release by the American Council for the Blind, click here.

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Last Modified: 08/08/2002

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