Federal court denies HHS request for delay in Medicare appeals backlog case

A DC federal court trial judge today denied the government’s request to delay further proceedings in a case brought by the AHA and three hospital organizations to compel the Department of Health and Human Services to meet its congressionally mandated deadlines for reviewing Medicare claims denials. “[T]he Court cannot conclude that the Secretary’s current proposals will result in meaningful progress to reduce the backlog and comply with the statutory deadlines,” Judge Boasberg states. “Although the Court remains loath to intervene in the legislative and executive branches’ efforts – or lack thereof, as it may be – to respond to the problem, its ‘ultimate obligation is to enforce the law as Congress has written it.’ The balance of interests drives the conclusion that there are equitable grounds for mandamus, and the Court will not issue a stay and further delay the proceedings." Melinda Hatton, AHA senior vice president and general counsel, praised the court’s decision, saying that it “rightly recognizes that HHS has neither developed nor even offered any realistic plan for resolving the backlog of appeals and that only a court order will ensure that it takes the immediate, concrete, and feasible steps necessary to come into compliance with the mandatory deadlines.” The government had requested a delay of the case until Sept.  30, 2017, arguing that such an extended delay was consistent with a February appellate court decision in the lawsuit. In February, the appeals court revived the lawsuit and sent the case back to the lower court, noting that the backlog of delays had gotten “worse, not better.” The appellate court also instructed that “in all likelihood,” the lower court should order the administration to comply with the appeals deadlines if HHS or Congress failed to make meaningful progress toward solving the problem within a reasonable period of time, pointing to the close of the next appropriations cycle as the deadline for resolution.