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Recent Industry News

Department of HHS OIG

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The United States District Court for the District of Columbia recently denied the Department of Health and Human Services (HHS) appeal to clear the Medicare appeals backlog.  HHS requested that the Court reconsider an order issued on December 5, 2016 to clear the backlog within four years.  HHS stated that meeting the statutory deadline would be difficult without “substantial new resources and authorities.”  The Court considered and rejected this argument, as HHS had previously presented a similar argument.  Unless HHS appeals the Court’s decision, this denial will conclude the two-and-a-half year pending litigation initiated by the American Hospital Association (AHA) and several hospitals.  The plaintiffs challenged HHS’s failure to meet the statutory timeframes for adjudication of Medicare claims appeals.

The Court adopted the following deadlines and mandatory percentage reductions to clear the current backlog of cases pending at the Administrative Law Judge (ALJ) level:

  • Thirty percent reduction of backlog by December 31, 2017;
  • Sixty percent reduction of the backlog by December 31, 2018;
  • Ninety percent reduction of the backlog by December 31, 2019; and
  • One hundred percent reduction of the backlog by December 31, 2020.

Health care providers and suppliers with pending appeals will welcome the Court action requiring HHS to take steps to comply with statutory deadlines for resolving appeals.  Governing law and regulations require ALJs to hold a hearing and render a decision within 90 days of filing of an appeal with the Office of Medicare Hearings and Appeals (OMHA).  However, ALJs have been unable to meet this deadline, resulting in a backlog of one million pending appeals.  A Government Accountability Office report released last June was highly critical of the HHS appeals process and the failure to meet deadlines.  Further, the OMHA moratorium on accepting new appeal requests has not been effective in reducing the backlog.

The District Court opinion is available at:

http://www.aha.org/content/17/170104aljdelayreconsdenied.pdf.

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