District Court Decision Reverses Medicare Appeal Council’s Denial of Skilled Nursing Care For Lack of Progress in Rehabilitation

In Papciak v. Sebelius (Civil Action No. 09-1354 (W.D. Pa. 2010)), the district court reversed a decision by the Medicare Appeals Council (MAC) that the nursing and therapy services provided to the plaintiff were “custodial,” rather than skilled, in nature due to the plaintiff’s “slow progress.” In reversing the denial of Medicare coverage, the court noted that the agency’s decision was not supported by substantial evidence in the record.

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