How “Observation Status” Affects the Rights of Medicare Patients

shutterstock_80114341-xsHouston Nursing Home LawsuitIt is an unfortunate fact of life that, as we age, our bodies take longer to heal from illness. As a result, many seniors require skilled nursing care after they have been discharged from their hospital stays to ensure their full recuperation. Fortunately, Medicare covers the first 100 days of care in a nursing facility, as long as patients were admitted to a hospital on the order of a physician and remained in the hospital for three consecutive days.

Fortunately, that is, in theory.

In reality, however, there is a loophole that can preclude seniors from being eligible for Medicare coverage of their stays in skilled nursing facilities following hospitalization, even if they were physically present in the hospital for at least three consecutive days. As crusaders for the rights of our elderly population, Marian Rosen and Angela Spears, attorneys located in Houston, Texas who are passionate advocates for the rights of the elderly and who have extensive experience in nursing home abuse litigation, want people throughout the country to know about this loophole and how it affects their rights.  Likewise, as the driving forces behind many a Houston nursing home lawsuit, they want people to take notice of litigation challenging this loophole and hopefully bringing this infringement of the rights of the elderly to an end.

When a Hospital Stay Isn’t a Hospital Stay

When patients are checked into hospitals with uncertain diagnoses or in cases in which the severity of their illnesses is unknown, they can be admitted under “observation status.”  This essentially means that they are remaining in the hospital in order to be observed, but are still officially classified as outpatients.  As a result, even if they are in the hospital for more than three consecutive days, Medicare does not recognize those days as instances of actual hospitalization.

Seniors who are admitted under “observation status” are forced to pay for their skilled nursing care out of pocket, which can mean thousands or even tens of thousands of dollars in bills.  The Center for Medicare Advocacy has reported cases in which seniors have stayed in the hospital for as long as two weeks, yet were still classified as outpatients under observation.

Bagnall v. Sebelius

In 2011, the non-profit organization, Center for Medicare Advocacy, filed a class action against Kathleen Sebelius, the then-United States Secretary of Health and Human Services.  Filed on behalf of Richard Bagnall and six other plaintiffs who were denied Medicare coverage for skilled nursing care after hospitalization due to the “observation status” loophole, the class action was dismissed by a Connecticut federal judge in September 2013.  The plaintiffs subsequently appealed, focusing their appeal on the right of Medicare beneficiaries to “an effective notice and review procedure” regarding their observation statuses.  A brief in response is due on May 15, 2014.

As attorneys who daily pursue their goal of seeing that our nation’s elderly live the quality lives they deserve, Marian Rosen and Angela Spears are keeping a watchful eye on the outcome of this litigation.

To learn more about this court case and its effect on you or your elderly loved one, please contact the law firm of Rosen & Spears today.

Tagged with: Nursing Home Abuse Personal Injury Wrongful Death

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About the Author: Marian Rosen