Can I sue Medicare, or the government, for poor nursing home care due to Medicare limits?

UPDATED: Jul 12, 2023Fact Checked

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Jeffrey Johnson

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Jul 12, 2023

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UPDATED: Jul 12, 2023Fact Checked

You likely do not have a legal right to sue Medicare or the government due to limited nursing home care.

When a person experiencing extensive medical treatment and/or staying in a nursing home hits the limits of Medicare’s coverage, any additional care required that exceeds the Medicare limit is not covered by the insurance.

In some situations, this might force the insured to make a choice, and simply go without the required care. Ultimately, the patient suffers as a result of Medicare’s limits and to someone in this unfortunate situation, it might seem logical to sue Medicare.

However, in a legal sense, the burden of responsibility for receiving proper care does not fall on Medicare. It falls on the caregivers, such as the doctors and hospitals, and it falls on the patient and/or his or her caregivers.

If a medical facility makes the decision to limit care due to limitations of medical insurance coverage, they can likely be held legally responsible, at least in some situations. If a patient or his or her caregivers made the decision to limit care because of Medicare coverage issues, even if they were forced by financial barriers to do so, they are considered legally responsible for that choice. The assumption is that it might be possible to seek care or funding elsewhere if the medical care is truly necessary, and the responsibility for doing this falls on the patient.

Case Studies: Exploring the Legal Implications of Nursing Home Care and Medicare Limits

Case Study 1: Mary’s Struggle for Adequate Care

Mary, a senior citizen, required extensive medical treatment and nursing home care due to her health condition. However, she reached the limits of Medicare coverage, which did not fully cover the additional care she needed. Faced with financial barriers, Mary and her caregivers were forced to make the difficult decision to limit her care. As a result, Mary’s health deteriorated. Can Mary sue Medicare or  home care she received?

Case Study 2: John’s Legal Battle Against a Medical Facility

John, an elderly patient, was receiving care at a nursing home. The medical facility decided to limit his care due to the limitations of Medicare coverage. Despite requiring additional care, John was denied the necessary treatment. As a result, his health worsened. Can John hold the medical facility legally responsible for limiting his care based on insurance coverage?

Case Study 3: Financial Barriers and Responsibility

In this case, a patient’s financial barriers prevented them from accessing the required care beyond Medicare’s coverage limits. Although the patient and their caregivers faced financial constraints, they made the decision to limit care due to Medicare coverage issues. Are they legally responsible for this choice, or can they hold Medicare accountable for the consequences?

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Jeffrey Johnson

Insurance Lawyer

Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

Insurance Lawyer

Editorial Guidelines: We are a free online resource for anyone interested in learning more about legal topics and insurance. Our goal is to be an objective, third-party resource for everything legal and insurance related. We update our site regularly, and all content is reviewed by experts.

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