Jimmo v. Sebelius – Medicare Lawsuit Summary

Jimmo V. Sebelius is a court case we have all been hearing about and reading about on the internet regarding quality of life. The case involved Medicare beneficiaries and The Center for Medicare Advocacy (non-for-profit) who filed a lawsuit regarding what they have termed the improvement standard by which Medicare beneficiaries who could benefit from services were denied services because they could not make enough progress. The Medicare regulations never held such language as the improvement standard; this was a general guideline that developed with increasing medical review of Medicare claims. Eventually, this standard was stated outright in claim denials for services such as therapy. The lack of progress was typically used to substantiate that the services were not medically necessary or worthwhile. Read more