Specialty Highlight Specialty Highlight: The U.S. District Court has just issued a very favorable ruling related to insurance carriers attempting to obtain medical records from DME suppliers who have already submitted a CMN to substantiate medical necessity. CIGNA attempt to recoup more than half a million in paid claims for motorized wheelchairs. The provider challenged the retroactive denials in numerous appeals and through an administrative hearing. These efforts all went against the provider on the basis that CIGNA had the right to request documentation of medical necessity above and beyond the information in the Certification of Medical Necessity. However, the wheelchair supplier challenged the decisions in the United States District Court and prevailed. The court stated that the law did not require suppliers to obtain and keep private medical records, second guess physicians’ professional conclusion by making medical necessity judgments themselves, and then inform beneficiaries prior to furnishing an item of “the likelihood of Medicare denial of payment.” This decision reinforces the position that all that is necessary to establish the medical necessity of a DME claim is the Certification of Medical Necessity. Read or post comments about this case at the User Forum discussion area specific to refunds. The published opinion can be viewed at - http://207.41.18.73/caed/DOCUMENTS/Opinions/Karlton/03-1584.pdf