Chronology of Dr. Nemechek’s Harassment by Medicare

The Beginning - Medicare decides to target Dr. Nemechek, and has Medical Director change immune globulin guidelines to ‘nab as corrective action’ against Dr. Nemechek. This action occurred prior to Medicare reviewing Dr. Nemechek's medical records concerning his use of immune globulin (IVIG).

August 1999 - Medicare issues first audit letter questioning Dr. Nemechek’s use of immune globulin in the treatment of antibody deficiency secondary to HIV infection.

January 2000 - Medicare claims Dr. Nemechek’s use of immune globulin was not according to Medicare guidelines and demands repayment of $168,783.

May 2000 - Medicare appeals process determines "the patient’s medical condition's met coverage specifications defined in the carrier's Local Medical Review Policy (LMRP) [treatment guidelines] and, as such, Dr. Nemechek was appropriately reimbursed for his care."

July 2000 - Medical Director for local Medicare carrier affirms in a letter to Dr. Nemechek that as long he was treating the patient’s antibody deficiency state and not directly treating HIV with antibody transfusions, that reimbursement would not be denied.

August 2001 - Medicare audits Dr. Nemechek again for the use of immune globulin in the treatment of antibody deficiency secondary to HIV infections; many of the patients records examined had previously been determined to qualify for coverage by Medicare in the first audit.

January 2002 - Medicare claims Dr. Nemechek’s use of immune globulin was not according to Medicare guidelines and demands repayment of $167,192.

September 2002 - Once again, Medicare appeals process determines Dr. Nemechek’s medical care was ‘appropriate and necessary’ and reverses repayment demand for immune globulin.

August 2004 - Medicare sends Dr. Nemechek a letter informing him of new rules (Medical Review) which effectively eliminate reimbursement of immune globulin for patients with antibody deficiency secondary to HIV infection.

August 2004 - Dr. Nemechek seeks help from regional Medicare office about Medicare carrier’s ongoing effort to prevent him from treating his HIV patients with immune globulin. Informs officials he is being set up for another audit.

August 2004 - Dr. Nemechek receives his third audit letter for the use of immune globulin in persons infected with HIV. Note: During all three audits, only patients with HIV are audit. None of Dr. Nemechek’s HIV negative patients receiving the same treatment were ever audited by Medicare.

September 1, 2004 - Because of new rules issued in Medical Review, Dr. Nemechek’s no longer can receive immune globulin because lack of reimbursement.

September, 2004 - Attorneys for Dr. Nemechek issue ‘demand letter’ to Medicare carrier.

September 2004 - Washington Congressional Representatives Moore, McCarthy and Ryun initiate inquires about Medicare’s persistent harassment of Dr. Nemechek and his HIV-infected patients.

October 2004 - Patient admitted to hospital because infection after having immune globulin therapy discontinued because payment by Medicare is discontinued.

October 6, 2004 - Dr. Nemechek holds town hall meeting giving patients, family and friends overview of Medicare harassment. See PowerPoint presentation for details.

October 2004 - Dr. Nemechek is encouraged by support from Congressional Representatives now including Senator’s Brownback, Roberts, Talent and Bond.

October 13, 2004 - Dr. Nemechek's legal counsel sends off for Freedom of Information Act (FOIA) petitions seeking information concerning information relevant to immune globulin regulations, HIV Disease and Dr. Nemechek in particular.

October 2004 - Medicare issues new proposal (LCD) to permanently prevent patients with HIV from ever receiving immune globulin for antibody deficiency.

November 2004 - Several FOIA petitions are rejected.

December 2004 - Patient develops pneumonia after having immune globulin reimbursement discontinued. Majority of patients who've had their immune globulin discontinued have had a drastic worsening of their fatigue, return of their drenching night sweats, and repeated sinusitis or bronchitis.

December 1, 2004 - Dr. Nemechek meets with Medicare carrier representatives and Kansas City Medicare officials. Carrier representatives admit they were “upset” their audits of me were overturned and that my medical care was found to be necessary and appropriate. They even admit they continued to audit Dr. Nemechek in spite of knowing his medical care had been determined to be appropriate in each prior audit.

December 4, 2004 - Dr. Nemechek receives phone call from aide to Senate Majority Leader (and former cardiac transplant Surgeon), Senator Bill Frist. Senator Frist is reported to be upset about the harassment Dr. Nemechek and his patients are receiving at the hands of local Medicare carrier. Senator Frist's office has recommended Senator Grassley (Senate Finance Committee Chairman) to have the issue investigated by Subcommittee on
Medicare Operations and Investigations.

January 10, 2005 - Dr. Nemechek delivers lengthy critique of proposed LCD during comment period. Critique includes letters from two researchers whose scientific research was used by Medicare to support their restriction of use immune globulin in patients with HIV. Both researchers wrote that their work was misrepresented, and believe patients with antibody deficiency secondary to HIV should be treated with immune globulin if clinically warranted.

January 20, 2005 - Appeals to previous FOIA denials are sent out.

January 26, 2005 - Senators Frist's office is still pursuing harassment issue through both CMS (Medicare) and the Senate Finance Committee Investigative Staff.

January 26, 2005 - Local American Civil Liberties Union (ACLU) official meets with Dr. Nemechek and agrees that the facts seem to point to repeated targeting of persons with HIV Disease. Official will present material to ACLU office in Washington, D.C. that specializes in HIV and AIDS-related issues.

January 27, 2005 - Attorney's for Dr. Nemechek receive phone call from senior Medicare employee stating that the prior FOIA denials were inaccurate and that the documents from those organizations would be forth coming.

January 28, 2005 - Senators Brownback and Talent's legislative staff believe there is no legislative remedy for present issue. Medicare is keeping them at bay by constantly framing this as a medical decision issue which the legislators have no authority in rather than being willing to respond to the charges of harassment of physicians and the targeting of HIV patients. Legislators are waiting for conclusion of Senate Finance Committee investigation

January 31, 2005 - Dr. Nemechek receives threatening phone call from Beth Gebielhaus, National Program Director for Medical Review, Medicare. After complaining that he feels like a target, Dr. Nemechek is told that "he is a target". Official states that treatment of HIV patients with immune globulin is completely inappropriate. She states that immune globulin is the "most abused medication in the country" because doctors give it only to make money. Official angrily tells Dr. Nemechek that his HIV patients don't deserve to receive immune globulin therapy in spite of the fact that upon appeal, other Medicare officials declared that his past use of immune globulin was "medically appropriate". After hearing this, she implied that she was going to call the office that supported the use of immune globulin in patients with HIV and put a stop to their support.

February 1, 2005 - Another patient who has been deprived of immune globulin from recent Medicare rule change develops bacterial pneumonia.

February 2, 2005 - Dr. Nemechek responds in writing to the threats he received from Medicare official on February 1, 2005.

February 2, 2005 - Another patient informs Dr. Nemechek he is moving to another part of the country where a different set of Medicare regulations would allow him to continue receiving immune globulin.

February 9, 2005 - A summary of comments submitted to Medicare concerning proposed their proposed IVIG LCD is posted on Kansas Medicare website. Medicare fails to mention that both scientists whose work was used to provide the scientific foundation for their dangerously restrictive rules submitted letters against Medicare's position that no persons shall receive off-label immune globulin for secondary immune deficiency. Additionally there is no mention of Medicare's complete failure to follow appropriate procedures in developing this LCD.

February 17, 2005 - Senator Bond's office is initiating a legislative inquiry through the central CMS office. Dr. Nemechek submits documentation and proposed questions to be addressed by CMS.

February 23, 2005 - Another patient who has been deprived immune globulin from recent Medicare rule change develops bacterial pneumonia.

February 24, 2005 - A patient who has been deprived of immune globulin from a recent Medicare rule change continues to loose weight since being discontinued from immune globulin with total weight lose of 43 lbs to date.

February 24, 2005 - Senator Christopher (Kit) Bond sends Mark McClellen, Director, Department of Health and Human Services, a letter requesting him to review repeated harassment of Dr. Nemechek and his patients.

March 1, 2005 - Patient who was previously receiving immune globulin through his private health insurance has now changed to Medicare as his primary form of health insurance because of his continuing disability. He will no longer be able to receive treatment with immune globulin because Medicare's restrictive new policy of immune globulin does not allow what was considered medically appropriate by the patient’s private medical insurance.

April 1, 2005 - The new region guidelines for IVIG become active. In spite of the numerous scientific and procedural flaws outlined in comments submitted by Dr. Nemechek during the open comment period, proposed guidelines are published intact without any changes making them the most restrictive guidelines for the use of immune globulin in immunodeficiency in the entire United States.

June 20, 2005 - Four patients who have been denied access to IVIG because of Medicare's new regulations file a petition in court to have the new regulations reviewed by an Administrative Law Judge.

September, 2005 - After a few delaying tactics, Medicare finally submits it response to the patients' petition to the ALJ court.

March, 2006 - The Administrative Law Judge finally submits his ruling in favor of Medicare without even holding a hearing to discuss this life-threatening issue.

April 13, 2006 - Patients quickly file an appeal of the judges ruling to a special committee in Washington, D.C.

January 10, 2007 – Final appeal to Medicare is denied.

February 2, 2007 – Patients declare their intent to have the LCD guidelines for IVIG reversed within the Federal Court system.

August 2007 – Patient’s file their brief in the U.S. Federal Court, Western District, Missouri.

June 30, 2008 – Judge Gary A. Fenner stands by the previous decision of the Administrative Law Judge and rules in favor of Medicare. The patients’ attorneys are surprised by the brevity and lack of detailed analysis of the Judges order.

July 14, 2008 – Patients indicate they want to go ahead with an appeal to the U.S. Federal Court of Appeals.