JUDGE DEFINES AND CERTIFIES NATIONWIDE CLASS IN MEDICARE PRESCRIPTION DRUG CASE

Low income enrollees in Medicare’s prescription drug program won an important procedural battle on January 12, 2007 when a federal court certified a nationwide class action in Situ v. Leavitt.

The case was filed by the National Senior Citizens Law Center and the Center for Medicare Advocacy on behalf of 6.4 million low income Medicare beneficiaries against the federal government for its failure to protect the rights of Medicaid beneficiaries in the Medicare prescription drug program.

Lead Counsel Jeanne Finberg, Directing Attorney at the National Senior Citizens Law Center, said, “The Court’s certification of  the class is a crucial step in our fight to protect the rights of some of our country’s poorest and sickest residents.”

Counsel for the Centers for Medicare & Medicaid Services (CMS), the responsible agency within the federal Department of Health and Human Services, argued that class status should not be granted because the Plaintiffs had not named specific policies or procedures behind the problems experienced by program participants.  The Court rejected the government’s argument, noting that CMS’ failure to carry out the Medicare Part D program adequately is sufficient grounds for certifying the class action.  The class is defined as all “full benefit dually eligible Medicare beneficiaries who have not received full benefits of Medicare Part D prescription drug coverage or the Low Income Subsidy program” because of poor plan enrollment management.  Beneficiaries must have filed a claim with CMS, a plan or the state, complaining of enrollment difficulties to formally considered members of the class.

“The federal government is taking its time to address the difficulties experienced by dual eligibles in accessing prescription medication,” continued Ms. Finberg.  “Meanwhile, real people are unable to get life-saving medicine or are being charged unfairly for services that the government must provide free of charge under Medicare Part D.  It’s unfortunate that we’ve been forced to litigate in order to get CMS to do its job.”

“Plaintiffs hope to force CMS to address the systematic failures of the system set up to manage the Medicare Part D program, with the larger goal of correcting the difficulties experienced by low income people struggling to obtain their prescription medications,” said Gill Deford, co-counsel in the case.  No damages are sought in the case.  “Dual eligibles,” who are eligible for both Medicare and Medicaid, rely on an average of ten more prescriptions than other elderly and disabled Medicare beneficiaries. 

For a copy of the judge's order, see Situ: Order Certifying a Nationwide Class PDF document — 105 KB

For further information on Medicare Part D, see http://www.nsclc.org/areas/medicare-part-d.

 

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