UPDATE (March 24, 2020)
A federal judge in Connecticut issued a favorable decision in this nationwide class action that gives hospital patients whose admission status was changed from “in patient” to “observation” the right to appeal. Read the Press Release.
Eighty-four-year-old Nancy Niemi of North Carolina was hospitalized for 39 days after her doctor sent her to the emergency room. It took weeks to stabilize her blood pressure and she experienced serious complications. But Ms. Niemi was categorized as an outpatient on “observation status” for her entire hospitalization, and she therefore lacked the three-day inpatient stay Medicare requires for coverage of her subsequent, very expensive care at a nursing home. Ms. Niemi’s son tried to help her challenge her lengthy placement on observation status, but Medicare did not allow beneficiaries to appeal this issue. She owed thousands of dollars to the nursing facility.
Justice in Aging filed this lawsuit in November 2011 with lead counsel, the Center for Medicare Advocacy. The case was appealed and returned to Federal District Court and the class was certified in 2017. In addition to attorneys from the Center for Medicare Advocacy and Justice in Aging, the class was represented by attorneys from the law firm of Wilson Sonsini Goodrich & Rosati.
On March 24, 2020, a federal judge in Connecticut issued a favorable decision in this nationwide class action. Now anyone who has had their status changed in the hospital from “in patient” to “observation” will have a right to appeal their classification and a chance to receive reimbursement from Medicare for the uncovered nursing facility charges. This decision impacts thousands of people across the country who may now receive reimbursement for thousands of dollars in uncovered care if they win their appeals.