A legal services perspectives on representing Medicare home health patients

The Medicare home health program lacks the basic legal protection for patients and providers that are commonplace in other public programs. These shortcomings include: 1. inadequate appeals procedures for both patients and providers; 2. overly restrictive eligibility criteria; 3. a lack of adequate public input into agency rule making and inadequate public information on specific coverage standards; 4. a reimbursement system that interferes with provider medical judgments. This is not the way the Medicare program was intended to run and the last few years have seen an increase in litigation to correct these problems. Such litigation is time-consuming and frustrating but experience shows that it is worth the trouble. As stated by a home health agency director whose patients were on the winning site of three recent lawsuits, "It takes tremendous effort, but you can beat the system."