Landers v. Leavitt

232 F.R.D. 42, 2005 U.S. Dist. LEXIS 23191, 2005 WL 2300380
CourtDistrict Court, D. Connecticut
DecidedSeptember 20, 2005
DocketNo. Civ.A. 3:04CV1988 (JCH)
StatusPublished
Cited by3 cases

This text of 232 F.R.D. 42 (Landers v. Leavitt) is published on Counsel Stack Legal Research, covering District Court, D. Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Landers v. Leavitt, 232 F.R.D. 42, 2005 U.S. Dist. LEXIS 23191, 2005 WL 2300380 (D. Conn. 2005).

Opinion

RULING ON PLAINTIFFS’ MOTIONS FOR CLASS CERTIFICATION [Doc. NOS. 8, 10 and 21]

HALL, District Judge.

The named plaintiffs are Medicare beneficiaries who were denied coverage for stays in a skilled nursing facility. Medicare, Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq., provides for coverage for such stays. However, the Medicare statute provides for coverage only where services are “furnished an individual after transfer from a hospital in which he was an inpatient for not less than 3 consecutive days before his discharge from the hospital in connection with such transfer.” 42 U.S.C. § 1395x(i). The named plaintiffs were denied coverage on the basis that they had not spent three or more days in a hospital prior to discharge to the nursing facility.

The plaintiffs challenge “the Secretary’s misinterpretation of the three-day qualifying stay requirement.” First Am. Compl. [Doc. No. 17] 111. The plaintiffs claim that the defendant failed to include time spent in the emergency room, or on observation status, in his calculation of the time spent in a hospital, contrary to applicable statutes, regulations, and the Equal Protection clause of the United States Constitution. The named plaintiffs seek to represent a class defined as the following:

All Medicare beneficiaries who (1) have been or will be in a hospital for at least three consecutive days prior to discharge from the hospital; (2) were or will be in the emergency room and/or in observation status for some portion of those days in the hospital; (3) were or will be admitted formally as an inpatient for at least one of those days; (4) after a claim has been or will be filed on their behalf, have been or will be denied Medicare coverage for skilled nursing facility care because of spending less than three days as a formally admitted patient; and (5) have or will have a claim pending for the Medicare coverage so denied at some level of the administrative process, or have filed or could timely file for review at either the next level of the administrative process or in federal district court, within sixty (60) days prior to the date of the filing of this complaint.

Mem. Points and Authorities Supp. Mot. Class Certification and Appointment of Class Counsel [Doc. No. 9] at 7-8.

The defendant (the “Secretary”) opposes the Motion for Class Certification. The Secretary argues that the court lacks jurisdic[44]*44tion over any persons who have not exhausted administrative remedies provided for by the Medicare statute. With respect to beneficiaries who have exhausted such remedies, the Secretary contends that class certification is inappropriate. First, it argues that the claims lack sufficient commonality of issues of law or fact to satisfy the requirements for certification of a class action. Second, it argues that the interests of the named plaintiffs are not sufficiently representative of those of the proposed class.

I. BACKGROUND

A. Medicare Coverage for Skilled Nursing Facility Care

Medicare, a federal program, provides both disabled persons and persons 65 and older with federal health insurance. Medicare Part A provides coverage for inpatient hospital stays and post-hospital services. 42 U.S.C. § 1395d(a),(b).1 Services covered by Part A include “inpatient hospital services” and “post-hospital extended care services.” Id. at § 1395d(a)(l), (2). “Extended care services” are defined by statute as services “furnished to an inpatient of a skilled nursing facility.” Id. at § 1395x(h). In order to be eligible for coverage, such services must be “post-hospital,” defined by statute as “extended care services furnished an individual after transfer from a hospital in which he was an inpatient for not less than 3 consecutive days before his discharge from the hospital in connection with such transfer.” Id. at § 1395x(i). Agency regulations further define requirements for coverage of a patient’s care at a skilled nursing facility. According to regulations, in order for services to be covered, “The beneficiary must (l)[h]ave been hospitalized in a participating or qualified hospital or [critical access hospital], for medically necessary inpatient hospital or inpatient [critical access hospital] care, for at least 3 consecutive calendar days, not counting the date of discharge; and (2)[h]ave been discharged from the hospital or [critical access hospital] in or after the month he or she attained age 65, or in a month for which he or she was entitled to hospital or [critical access hospital] insurance benefits ...” Id. at § 409.30(a)(1), (2). Further, “the beneficiary must be in need of posthospital [skilled nursing facility] care, be admitted to the facility, and receive the needed care within 30 calendar days after the date of discharge from a hospital or [critical access hospital].” Id. at § 409.30(b)(1).

B. The Named Plaintiffs

Three named plaintiffs seek to represent the proposed class. They claim to have been denied nursing facility coverage despite having spent at least three days in a hospital prior to discharge to the skilled nursing facility. For purposes of this motion, the court considers the facts as true as alleged by the plaintiffs in their complaint. First Am. Compl. [Doc. No. 17]. All three plaintiffs reside in Connecticut and have at all relevant times been eligible for both Medicare Parts A and B.

Suffering back pain and pain in her left leg and hip, Marion Landers, age 101, visited a hospital emergency room on April 20, 2001. She remained in the emergency room until April 21, at which time the hospital formally admitted her as an inpatient. Prior to her admission as an inpatient, hospital staff administered to Landers intravenous subcutaneous morphine for severe pain and Landers underwent a computerized axial tomography (CAT) scan and magnetic resonance imaging (MRI) of her hip in the hospital. Following her admission, she continued to receive intravenous morphine and had an orthopedic consultation. On April 23, she was discharged and transferred to Avery Heights, a skilled nursing facility. Landers was denied coverage for her stay at Avery Heights. She exhausted available administrative remedies prior to filing the instant lawsuit. She has since paid the cost of her care at Avery Heights, $11,610.

Suffering nausea, lightheadedness, and vomiting, Marion A. Dixon, age 76, visited a hospital emergency room on December 21, 2003. In the emergency room, he received [45]*45intravenous fluids and prescription medications and underwent blood work and a CAT scan. On December 22, he was transferred to observation status. He was formally admitted as an inpatient on December 23, after having spent two days in the emergency room. He was diagnosed with pneumonia and began taking intravenous Levaquin. On December 24, Dixon was discharged to a skilled nursing facility, where he was treated until January 27, 2004. Dixon submitted claims for coverage of his treatment at the nursing facility, both of which were denied. Reconsideration of such denial was rejected. Dixon has not yet completed the administrative review process. He has paid the cost of his stay in the nursing facility, $11,050.

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Related

Estate of Gardner v. Continental Casualty Co.
316 F.R.D. 57 (D. Connecticut, 2016)
Estate of Landers v. Leavitt
Second Circuit, 2009
Estate of Landers Ex Rel. Landers v. Leavitt
545 F.3d 98 (Second Circuit, 2008)

Cite This Page — Counsel Stack

Bluebook (online)
232 F.R.D. 42, 2005 U.S. Dist. LEXIS 23191, 2005 WL 2300380, Counsel Stack Legal Research, https://law.counselstack.com/opinion/landers-v-leavitt-ctd-2005.