The Bush administration has told Medicare contractors to stop automatically denying Medicare payments to people with Alzheimer's disease.
Because of evidence of fraud over several years, the Centers for Medicare and Medicaid, which administers healthcare services for Americans aged over 65 and for people with low income, had cautioned its contractors to be sceptical of claims relating to patients with Alzheimer's disease. For example, some healthcare providers were billing for treatment for patients who had deteriorated so much that no benefit would result.
To avoid paying such dubious claims, about 20 of the 50 Medicare contractors that process claims for the centres had established computer systems that automatically denied payment of claims relating to Alzheimer's disease. In some of these cases, however, payment might eventually be won after a lengthy appeals process.
Late last year, after two years of lobbying by the Alzheimer's Association and the American Bar Association's Commission on Legal Problems of the Elderly, the centres notified the 50 Medicare contractors that they could no longer issue blanket denials of payments for treatment of Alzheimer's disease.
A statement issued last week by the centres' administrator, Tom Scully, said: “Advances in medical science are helping physicians diagnose Alzheimer's disease in its earliest stages. Depending on a beneficiary's medical condition, the Centers for Medicare and Medicaid Services believe that certain specific therapies can be helpful in slowing a beneficiary's decline due to this terrible illness.”
The centres had therefore issued instructions to Medicare contractors not to install systems that would automatically deny Medicare covered services to patients with dementia.