Court Finds Medicare Policy Unlawful
A federal district court last month found Medicare and some of its contractors had unlawfully limited payments for DuoNeb, an inhalation drug used to treat chronic obstructive pulmonary disease, according to The New York Times.
The Bush administration argued in the Oct. 16 test case that Medicare officials had the right to decide whether the expense incurred for a given item, not just the item itself, was “reasonable and necessary.”
U.S. District Court Judge Henry H. Kennedy Jr. said the policy of paying for only “the least costly alternative” was not permitted under the Medicare law. Congress set Medicare payment rates and never intended to give officials broad discretion to alter them, the court said.
“We are disappointed with the ruling and continue to believe that our policy is supported by the statute,” Peter L. Ashkenaz, a Centers for Medicare & Medicaid Services (CMS) spokesman said. “We are still considering our options and next steps.”