Warren Albert, D.C. et al v. Sebelius et al
||NY Chiropractic Care, P.C. and Warren Albert, D.C.
||Kathleen Sebelius and United States Department of Health and Human Services
||August 12, 2013
||US District Court for the Eastern District of New York
||Robert M. Levy
|Nature of Suit:
||Contract: Recovery Medicare
|Cause of Action:
||42:1395 HHS: Adverse Reimbursement Review
|Jury Demanded By:
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|July 28, 2015
MEMORANDUM & ORDER: The Defendant's motion 18 for judgment on the pleadings is DENIED and Plaintiff's motion 20 for judgment on the pleadings is GRANTED. The Court reverses the decision of the Council and remands for further proceedings consistent with this opinion pursuant to the fourthsentence of 42 U.S.C. § 405(g). On remand, the Council shall reconsider whether Dr. Alberts services were reimbursable in light of a correct interpretation of the relevant documentation guideli nes. For guidance on remand, the Council shall not deny Dr. Alberts claims solely for failure to submit an eight-element medical history, but rather shall considerwhether the medical history he did submit, when taken in totality with his other treatm ent notes, demonstrates that the patient ha[s] a significant health problem in the form of a neuro-musculoskeletal condition necessitating treatment and that the manipulative services rendered... have a direct therapeutic relationship to the patients condition and provide reasonable expectation of recovery or improvement of function. Ordered by Judge Frederic Block on 7/28/2015. (Innelli, Michael)
|January 30, 2015
MEMORANDUM AND ORDER: The Court requests supplementary briefing and oral argument on two questions: (1) What level of deference should the Court apply to the Medicare Appeals Councils interpretation of the relevant LCD? (2) Should the Court defer to the Councils interpretation in this case? Written submissions are due by March 30, 2015. Oral argument is scheduled for April 17, 2015, at 11:00 a.m. Ordered by Judge Frederic Block on 1/30/2015. (Innelli, Michael)
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