[Federal Register Volume 67, Number 226 (Friday, November 22, 2002)]
[Notices]
[Page 70444]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-29128]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services


Notice of Proposed Settlement and Fairness Hearing

    We are giving 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 may 
request 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.

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, [email protected].
Dina Lesperance, Arizona Center for Disability Law, 3839 N. Third St., 
Suite 209, Tucson, AZ 85012-2069.
Gill Deford, Center for Medicare Advocacy, Inc., P.O. Box 350, 
Willimantic, CT 06266, (860) 456-7790.

Counsel for Defendant

    Counsel for Defendant is: Ori Lev, United States Department of 
Justice, P.O. Box 883, Washington, DC 20044.

    Dated: November 6, 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. 02-29128 Filed 11-21-02; 8:45 am]
BILLING CODE 4120-03-P