[Federal Register: November 22, 2002 (Volume 67, Number 226)]
[Notices]
[Page 70443-70444]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr22no02-86]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
Notice of Proposed Settlement and Fairness Hearing
The Centers for Medicare and Medicaid Services gives notice that if
you are a medicare beneficiary you may be a member of a class action
lawsuit involving local coverage policies. This case challenges, among
other things, the notice given when claims are denied by Medicare based
on local coverage policies. The United States District Court for the
District of Arizona has certified a nationwide class action in this
case, Erringer v. Thompson, No. CV 01-112 TUC BPV (D. Ariz.), and the
parties have submitted a proposed Settlement Agreement to the Court for
its approval. You have the right to receive a copy of, and comment on,
the proposed settlement Agreement. To receive a copy of the Agreement,
please write or email class counsel at one of the addresses listed
below. A copy of the proposed Agreement is also available on the Web
at: http://www.acdl.com/legalnews.html. If you want to comment on the
proposed Agreement, you must submit written comments to the Court.
Summary of Agreement
The proposed Agreement settles all claims relating to the initial
notice provided to Medicare beneficiaries, whose claims for payment are
denied in whole or in part based on application of a Local Medical
Review Policy (LMRP) or a Local Coverage Determination (LCD),
regarding: (i) the use of such policies in the determination of a
beneficiary's claim for benefits, and (ii) the beneficiary's
opportunity to provide additional evidence or information in support of
his/her claim for benefits. In exchange for Plaintiffs releasing all
such claims, Defendant agrees to provide beneficiaries whose claims are
denied based on an LMRP or LCD notice that: (1) An LMRP or LCD was used
in making the decision to deny their claim; (2) an LMRP or LCD provides
a guide to assist in determining whether a particular item or service
is covered by Medicare; (3) a copy of the LMRP or LCD is available from
the local intermediary or carrier by calling the toll free telephone
number listed on the beneficiary's Medicare Summary Notice; (4) the
beneficiary can compare the facts in his/her case to the guidelines set
out in the LMRP or LCD to see whether additional information from his/
her physician might change Medicare's decision; and (5) the beneficiary
may also send any additional information regarding any appeal. The
Agreement also provides for a way that beneficiaries may receive a copy
of the LMRP or LCD used in their case, provides for monitoring of
Medicare contractors' compliance with the proposed Agreement's
provisions, and provides for a payment of $23,061 in attorney's fees
and costs to Plaintiffs' counsel.
Fairness Hearing
The Court will conduct a fairness hearing before Magistrate Judge
Bernardo P. Velasco, at the United States District Court, Evo A.
DeConcini U.S. Courthouse, 405 W. Congress Street, Tucson, Arizona
85701, on February 3, 2003, at 9 a.m., to determine whether to approve
the proposed Agreement as fair, adequate and reasonable. Objections to
the proposed Agreement will be considered by the Court if such
objections are filed in writing with the Clerk of Court at the above
address, on or before December 31, 2002. Attendance at the hearing is
not necessary to have an objection considered; however, class members
wishing to be heard orally in opposition to the proposed Agreement
should indicate in their written objection their intention to appear at
the hearing.
[[Page 70444]]
Class Counsel
The attorneys representing the plaintiffs and the class as class
counsel are:
Sally Hart, Arizona Center for Disability Law and Center for Medicare
Advocacy, Inc., 100 N. Stone Ave., Suite 305, Tucson, AZ 85701. (520)
327-9547. shart@acdl.com.
Dina Lesperance, Arizona Center for Disability Law, 3839 N. Third St.,
Suite 209, Tucson, AZ 85012-2069.
Gill Deford, Center for Medicare Advocacy, Inc., PO Box 350,
Willimantic, CT 06266. (860) 456-7790.
Counsel for Defendant
Counsel for Defendant is:
Ori Lev, United States Department of Justice, PO Box 883, Washington,
DC 20044.
Dated: November 5, 2002.
John P. Burke III,
Paperwork Reduction Act Team Leader, CMS Reports Clearance Officer,
Office of Strategic Operations and Strategic Affairs, Division of
Regulations Development and Issuances.
[FR Doc. 02-28873 Filed 11-21-02; 8:45 am]
BILLING CODE 4120-03-P