Appeals: Court keeps HHS in hot seat

Friday, January 6, 2017

WASHINGTON – The U.S. District Court for the District of Columbia stands firm that the Department of Health and Human Services must implement procedures to curtail a massive appeals backlog in a timely fashion.

Judge James Broasberg on Jan. 4 refused to rescind his previous order on Dec. 5 requiring the agency to eliminate the 650,000-claim backlog before 2021. HHS had argued that it would only be able to meet such a deadline by paying for claims without regard to merit.

The court was not unsympathetic to HHS’s plight, Broasberg wrote in his decision, but “(it) must follow the instructions of the D.C. Circuit and…conclude that equitable grounds existed for (relief) and that the reductions timetable was the most appropriate form of such relief.”

Prior to Broasberg’s Dec. 5 order, HHS had asked the court not to intervene in the appeals process, citing a number of administrative and legislative actions it was taking to eliminate the backlog by 2019. One of those actions: HHS recently offered to settle disputed claims for inpatient services—a large portion of the claims at issue—for 66 cents on the dollar. A similar offer in 2014 resulted in the settlement of 350,000 claims for about $1.5 billion.

Previously, in September, the court denied HHS’s request to put litigation with the American Hospital Association on hold until Sept. 30, 2017.