Circuit Court Rules for Medicare Beneficiaries

Second Circuit Rules Medicare Beneficiaries Can Combine Claims for Judicial Review;  Fourth District Court Rules for Glucose Monitors

On September 23, 2020, the United States Second Circuit Court of Appeals found that Medicare beneficiaries can combine claims denied by Medicare to meet the dollar amount necessary for judicial review.  See Bloom v. Azar.  Medicare had alleged that Medicare beneficiaries could not get judicial review unless they combined all their denied claims at the administrative law judge level.  Medicare’s position would have precluded judicial review of most claims denied by Medicare and appealed by Medicare beneficiaries.  The Circuit Court case followed a third District Court ruling that Medicare must cover continuous glucose monitors (CGMs).  In that third District Court case, the judge found that Medicare had to cover one of Dr. Bloom’s CGM claims, but found two other claims did not meet the amount in controversy for judicial review.  The Second Circuit has reversed that District Court finding allowing recovery on all three claims.  Parrish Law Offices represented Dr. Bloom before the Second Circuit.

Separately, on September 22, 2020, the District Court for the Northern District of California found that Medicare’s assertion that CGMs are not “primarily and customarily used to serve a medical purpose” was not reasonable and not entitled to deference.  See Zieroth v. Azar.  Accordingly, the District Court ordered coverage of CGM claims.  The ruling reflects the fourth District Court ruling that Medicare’s position that CGM do not serve a medical purpose is contrary to law.  Parrish Law Offices was co-counsel on the case. 

Despite these victories, Medicare beneficiaries still face significant hurdles securing access to CGM technology.  Medicare and Medicare Advantage Plans continue to deny coverage of some CGMs.  Parrish Law Offices represented the Medicare beneficiaries who sued a Medicare Advantage Plan and Medicare in District Courts in Wisconsin, Vermont, California and Massachusetts for coverage of CGM devices.  In addition, Parrish Law Offices has filed a class action in the District of Columbia seeking coverage going back to 2012 for Medicare beneficiaries whose CGM claims were denied.