Davidson v. Thompson

No. CIV 04-32 LFG (D. N.M. Dec. 1, 2004) ; Clearinghouse Number: 55901

Description

Vision-Impaired Medicare Beneficiary Entitled to Reimbursement for Closed Circuit Television Electronic Vision Enhancement Device

Abstract

The district court reversed a final administrative decision of defendant secretary of health and human services denying plaintiff Medicare Part B coverage for a closed circuit television (CCTV) electronic vision enhancement device prescribed by her doctor. Plaintiff Medicare beneficiary had suffered a sudden macular hemorrhage resulting in macular degeneration—a retinal disorder destroying all but her peripheral vision. She argued that the CCTV device was reimbursable under Part B as durable medical equipment or a prosthetic device, as defined in the Medicare statute and regulations. Applying the standard set forth in Chipman v. Shalala, 90 F. 3d 421 (10th Cir. 1996), the court found that secretary’s denial of plaintiff’s claim was not supported by the record. The court said that plaintiff’s doctor prescribed the CCTV specifically due to her serious medical condition. According to the court, congressional intent as expressed in the legislative history of the Medicare Act excluded from coverage routine procedures and devices unconnected with major medical conditions such as plaintiff’s macular hemorrhage and degeneration.

Additional Information

Attorney Information
Plaintiff represented by Michael Parks, Senior Citizens' Law Office, 4317 Lead Ave. SE, Albuquerque, NM 87108 (505.265.2300).
Docket Date
2004-12-01 00:00:00+00:00
Attorney Email
mparks@sclo.net