Court orders HHS to eliminate ALJ appeals backlog

A federal judge yesterday ordered the Department of Health and Human Services to eliminate the backlog of Medicare claims appeals pending at the administrative law judge level within four years, granting summary judgment to AHA and three member hospitals in their case challenging HHS for failing to meet statutory deadlines for processing Medicare claims appeals. Judge James Boasberg of the U.S. District Court for the District of Columbia ordered HHS to reduce the backlog of cases 30% by Dec. 31, 2017; 60% by Dec. 31, 2018; 90% by Dec. 31, 2019; and 100% by Dec. 31, 2020; and to file status reports with the court every 90 days. “Plaintiffs sought relief from a morass in which hundreds of thousands of appeals were languishing in a highly backlogged administrative process,” the opinion states. “Now, after a motion for summary judgment, a motion to dismiss for lack of jurisdiction, an appeal to and remand from the D.C. Circuit, and a motion to stay, the Court can finally grant Plaintiffs a remedy. The incantation of mandamus does not generate an instantaneous cure-all for complex problems, however, and so this Opinion focuses on the form the relief will take.” AHA General Counsel Melinda Hatton said the decision “is a victory for hospitals that continue to have billions of dollars in Medicare reimbursement tied up in a heavily backlogged appeals system. To meet the court-ordered backlog reductions, we trust that HHS will implement real reforms critical to resolving the backlog, including fundamental reforms of the Recovery Audit Contractor program.”