Observational Vs. Admitted: CT Advocates Win Class Status For Suit Challenging Medicare Benefits – Hartford Courant

A Connecticut advocacy group has won class certification for a lawsuit demanding that Medicare beneficiaries be allowed to challenge their patient classification as “observational” rather than “admitted” when hospitalized — a distinction that can cost thousands of additional dollars in hospital, medication and nursing home care.

Recent estimates suggest that as many as 1 million Medicare beneficiaries are hospitalized around the country each year under observational status. Until May, hospitals were under no obligation to notify the patients that they were not admitted and the patients learned only upon being billed for significant medical and post-release nursing care.

Under Medicare rules, beneficiaries are not permitted to challenge their classification.

The suit was brought six years ago by the Willimantic-based Center for Medicare Advocacy, which represents beneficiaries across the country. U.S. District Judge Michael P. Shea in Hartford certified the suit as a class action in a decision made public Tuesday. Should the center prevail, hundreds of thousands of beneficiaries forced to pay higher costs could benefit.


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