WSGR Assists Center for Medicare Advocacy in Pro Bono Class Action Lawsuit

A WSGR pro bono team is assisting the Center for Medicare Advocacy in an ongoing class action lawsuit challenging the alleged use by the Department of Health and Human Services of a clandestine and unlawful standard—commonly referred to as the "improvement standard"—for determining whether Medicare beneficiaries are entitled to coverage. The lawsuit, which is pending in the U.S. District Court for the District of Vermont before Chief Judge Christina Reiss, seeks to ensure that patients with chronic conditions do not have their benefits denied because the proposed care will not improve the patients' conditions. Specifically, the plaintiffs allege that through utilization of the improvement standard, patients with chronic conditions that are not expected to improve are improperly denied coverage for skilled care that is often necessary to slow disease progress, maintain basic functionality, and prevent further deterioration.

The government initially moved to dismiss the case in its entirety. On October 25, 2011, Judge Reiss issued an order on the government's motion to dismiss, rejecting most of the government's arguments and allowing the case to proceed on its merits. In response to this order and following negotiations between the parties, the government requested additional time to consider the possibility of settling the claims. Accordingly, on January 10, 2012, Judge Reiss granted a stipulated stay of 30 days at the request of the U.S. Secretary of Health and Human Services, Kathleen Sebelius, for the secretary to evaluate and respond to a settlement proposal forwarded by the plaintiffs.

Wilson Sonsini Goodrich & Rosati is proud of its involvement in this litigation, as the "improvement standard" presents significant hardship to thousands of individuals across the country who suffer from chronic illness for which improvement is often not possible.