Skip to Content

Tag: ALJ


News

HHS reports 25% reduction in appeals backlog

October 16, 2019HME News Staff

WASHINGTON - The Department of Health and Human Services has reduced the backlog of Medicare appeals at the administrative law judge level by 25% through June 30, according to a status report provided to a federal court and obtained by the American Hospital Association.The status report is part of a federal court ruling last year that established annual deadline-based targets for reducing the backlog of Medicare appeals at the ALJ level.From Nov. 1, 2018, through the end of the third quarter of fiscal...

AHA, ALJ, Appeals backlog, OMHA


Read Full Articlered right arrow icon

News

New court decision on recoupments

February 15, 2019Liz Beaulieu, Editor

WASHINGTON - Healthcare attorney Elizabeth Hogue has been watching closely as numerous courts go back and forth on whether or not CMS should be stopped from recouping overpayments until after the ALJ level, but she thinks a recent court's decision is “really serious.”Here's what Hogue had to say about a Florida district court's decision to deny a home health agency's request for a preliminary injunction to stop recoupments before an ALJ hearing on the grounds that providers do not have...

ALJ, Elizabeth Hogue


Read Full Articlered right arrow icon

News

CMS expands phone demo

October 23, 2018HME News Staff

JACKSONVILLE, Fla. - CMS will expand a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases to jurisdictions A and B on Nov. 1.The agency cited “strong support from the supplier community and the initial success of the demonstration” as reasons to expand the phone demo.“Effective on or after Nov. 1, the DME QIC will offer telephone discussions and/or re-openings to DME suppliers within the DME MAC Jurisdictions...

ALJ, appeals, C2C Innovative Solutions, phone demo, QIC


Read Full Articlered right arrow icon

News

Lack of unified stance on settlements, poll finds

October 12, 2018Liz Beaulieu, Editor

YARMOUTH, Maine - It turns out, even with the huge backlog of Medicare appeals stuck at the administrative law judge level, whether or not to accept a settlement is as divisive an issue as it gets in the HME industry.The respondents to a recent HME Newspoll were evenly divided on the issue, with 50% feeling the need to take a stand and 50% feeling the need to take the money and run.“Why should CMS be left off the hook and rewarded for messing things up in the first place?” wrote one respondent....

aahomecare, ALJ, Appeals backlog, Home Medical Equipment


Read Full Articlered right arrow icon

Also Noted

Another court issues TRO on CMS

July 24, 2018HME News Staff

BROWNSVILLE, Texas - A court has again issued a temporary restraining order prohibiting CMS from recouping overpayments until after the administrative law judge level, this time on behalf of Adams EMS, according to healthcare attorney Elizabeth Hogue. In June, the U.S. District Court for the Northern District of Texas issued a TRO on behalf of Family Rehabilitation. In this most recent case before the U.S. District Court for the Southern District of Texas, Health Integrity, a ZPIC, determined that...

ALJ, recoupment, temporary restraining order


Read Full Articlered right arrow icon

News

Court agrees broken appeals systems is unfair

June 22, 2018Liz Beaulieu, Editor

DALLAS - A U.S. District Court's recent opinion prohibiting CMS from recouping alleged overpayments from a provider going through the appeals process until after the administrative law judge level sends a strong message, industry stakeholders say.As part of the June 4 opinion, Judge Ed Kinkeade of the U.S. District Court for the Northern District of Texas agreed to issue a temporary restraining order against CMS, the latest development in Family Rehabilitation, Inc. vs. Azar.“The system, which...

ALJ, appeals, backlog, Medicare, temporary restraining order


Read Full Articlered right arrow icon

Guest Blog

Judge getting impatient with HHS over massive ALJ backlog

April 6, 2018HME News Staff

I recently wrote an article entitled "Court Says No Recoupment Until After ALJ Hearings."  This article was about a court decision in which the judge said that recoupment of an extrapolated overpayment as a result of a ZPIC audit could not begin until after ALJ hearings were held. This article is reprinted below in italics. Now comes potentially additional good news! As you may recall, the American Hospital Association (AHA) and others sued the U.S. Department of Health and Human Services...

ALJ, audits, backlog


Read Full Articlered right arrow icon

News

HHS details status of appeals backlog

November 29, 2017HME News Staff

FALLS CHURCH, Va. - The Office of Medicare Hearings and Appeals receives more than a year's worth of appeals work every 24 weeks at the third level of appeals, according to a recent PDF posted to the agency's website.As of the end of the fourth quarter of fiscal year 2016, the pending workload at the administrative law judge level exceeded 650,000 appeals, while annual adjudication capacity going forward was about 92,000 appeals, according to the “HHS Primer: The Medicare Appeals Process.”At...

ALJ, appeals, backlog, OMHA


Read Full Articlered right arrow icon

Medtrade Show Daily

Session spotlight: Be prepared for your day in court

October 24, 2017Jeff Rowe

ATLANTA - Many HME providers end up in front of an administrative law judge to contest a reimbursement denial, but too often they don't know what they're up against, says speaker Ross Burris.In the session “What Really Happens In An ALJ Hearing?” today at Medtrade, Burris, an attorney with Polisinelli, will be part of a panel that will walk attendees through how to prepare and manage an ALJ hearing.HME News:Why is there a need for a session like this?Ross Burris:A lot of providers decide...

ALJ, appeals, Ross Burris


Read Full Articlered right arrow icon

News

CMS contractor expands phone demo

November 4, 2016Liz Beaulieu, Editor

JACKSONVILLE, Fla. - C2C Innovative Solutions, the contractor handling the second level of the Medicare appeals process, has received the green light from CMS to expand a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases.C2C, CMS's Qualified Independent Contractor or QIC, received word from the agency on Nov. 1 that it can open the demo to all product categories, with the exception of power mobility devices, Daniel...

ALJ, audits, C2C Innovative Solutions, Medicare appeals


Read Full Articlered right arrow icon