Expect longer delays at the ALJ

Wednesday, October 30, 2013

WASHINGTON – The Office of Medicare Hearings and Appeals (OMHA) will defer assignments for hearings—possibly up to 28 months, according to a recent notice.

Requests for hearings received after July 15, 2013, will be entered into the agency’s case processing system and held until there is room on an Administrative Law Judge’s (ALJ) docket for adjudication. When a request is assigned, a notice will be sent, according to the notice.

The ALJs have been backlogged for more than a year, thanks to increased levels of audits and appeals.

The notice also sates that OHMA will continue to process Part D prescription drug denial cases that qualify for expedited status within 10 days and will screen all incoming requests to make sure beneficiary issues are prioritized.



For those NOT fully understanding the entire Appeal process: the MAC will begin an offset during this portion of "The Appeal Process".  The statute allows for any offset to begin after re-determination or medical review has been completed!!!  Appeals for ALJ consideration do NOT suspend the offset process!!!

NOTE: any offset is taken at ANY extrapolated amount that may be imposed!!!

Also the ALJ does NOT have any jurisdiction to delay or stop ANY offset in advance of The ALJ Decision!!

Chronologically from the info in this article you are now looking at a potential 3 to 5 year window after your medical review or re-determination process for any ALJ Appeal Determination for claims!!!  Wow!!!

Plenty of time to deplete any entity of a significant amount of cash!!!