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Medicare Patients Entitled To Receive Investigation Results

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JUNE 30, 2003 VOLUME 10, NUMBER 52

Like other patients, Medicare beneficiaries sometimes receive poor medical care. When a Medicare patient complains about the quality of his or her care, federal law mandates a formal review process. It also requires that the patient be informed of the results of that review. Until a recent federal court decision, the government took the position that simply telling the patient the matter was being “looked into” was enough.

Doris Shipp was a patient at Baptist East Hospital in Louisville, Kentucky, from December, 1998, until her death from cancer in June, 1999. After her death her husband David Shipp wrote to the Peer Review Organization (PRO) responsible for oversight of Baptist and the three physicians treating Mrs. Shipp, asking for a review of the quality of care she had received.

Because two of the physicians refused permission to disclose the results of the PRO review of care, Mr. Shipp received a letter informing him only that the PRO had “carefully examined all the issues raised in your correspondence and conducted a thorough review of the care your wife received.” The notice also, unhelpfully, informed Mr. Shipp that the PRO “will take all necessary action when our review findings warrant it.”

Mr. Shipp sought help from Public Citizen, Inc., a nonprofit consumer advocacy group. Public Citizen filed a federal court lawsuit seeking more information for Mr. Shipp and other patients (or survivors) who have concerns about the quality of Medicare services. The Federal District Court agreed with Public Citizen and ordered the government to change its rules to require PROs to actually provide information to patients about the results of their investigations.

The U.S. Court of Appeals for the District of Columbia Circuit agreed with the trial court, and upheld the order invalidating federal rules. At a minimum, ruled the appellate court, the PRO must “disclose its determination as to whether the quality of the services that the recipient received met ‘professionally recognized standards of health care.’” The case was returned to the District Court for further proceedings—partly to determine whether the new government rules must also provide for disclosure of any corrective action by the PRO. Public Citizen, Inc., v. U.S. Dep’t of Health and Human Services, June 20, 2003.

Since Mrs. Shipp’s death the government has changed the name of PROs to “Quality Improvement Organizations.” As a result of the case pursued in Mrs. Shipp’s name, quality of care should now be somewhat easier for Medicare patients to monitor. Thanks go in part to Mr. Shipp’s persistence, partly to Public Citizen, Inc., and partly to The Center for Medicare Advocacy and AARP, which filed a brief supporting Public Citizen’s position.

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Robert B. Fleming


Robert Fleming is a Fellow of both the American College of Trust and Estate Counsel and the National Academy of Elder Law Attorneys. He has been certified as a Specialist in Estate and Trust Law by the State Bar of Arizona‘s Board of Legal Specialization, and he is also a Certified Elder Law Attorney by the National Elder Law Foundation. Robert has a long history of involvement in local, state and national organizations. He is most proud of his instrumental involvement in the Special Needs Alliance, the premier national organization for lawyers dealing with special needs trusts and planning.

Robert has two adult children, two young grandchildren and a wife of over fifty years. He is devoted to all of them. He is also very fond of Rosalind Franklin (his office companion corgi), and his homebound cat Muninn. He just likes people, their pets and their stories.

Elizabeth N.R. Friman


Elizabeth Noble Rollings Friman is a principal and licensed fiduciary at Fleming & Curti, PLC. Elizabeth enjoys estate planning and helping families navigate trust and probate administrations. She is passionate about the fiduciary work that she performs as a trustee, personal representative, guardian, and conservator. Elizabeth works with CPAs, financial professionals, case managers, and medical providers to tailor solutions to complex family challenges. Elizabeth is often called upon to serve as a neutral party so that families can avoid protracted legal conflict. Elizabeth relies on the expertise of her team at Fleming & Curti, and as the Firm approaches its third decade, she is proud of the culture of care and consideration that the Firm embodies. Finding workable solutions to sensitive and complex family challenges is something that Elizabeth and the Fleming & Curti team do well.

Amy F. Matheson


Amy Farrell Matheson has worked as an attorney at Fleming & Curti since 2006. A member of the Southern Arizona Estate Planning Council, she is primarily responsible for estate planning and probate matters.

Amy graduated from Wellesley College with a double major in political science and English. She is an honors graduate of Suffolk University Law School and has been admitted to practice in Arizona, Massachusetts, New York, and the District of Columbia.

Prior to joining Fleming & Curti, Amy worked for American Public Television in Boston, and with the international trade group at White & Case, LLP, in Washington, D.C.

Amy’s husband, Tom, is an astronomer at NOIRLab and the Head of Time Domain Services, whose main project is ANTARES. Sadly, this does not involve actual time travel. Amy’s twin daughters are high school students; Finn, her Irish Red and White Setter, remains a puppy at heart.

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Matthew M. Mansour


Matthew is a law clerk who recently earned his law degree from the University of Arizona James E. Rogers College of Law. His undergraduate degree is in psychology from the University of California, Santa Barbara. Matthew has had a passion for advocacy in the Tucson community since his time as a law student representative in the Workers’ Rights Clinic. He also has worked in both the Pima County Attorney’s Office and the Pima County Public Defender’s Office. He enjoys playing basketball, caring for his cat, and listening to audiobooks narrated by the authors.