Tag: ALJ

ATLANTA – The Office of Medicare Hearings and Appeals should be caught up on a years-long backlog of appeals at the administrative law judge (ALJ) level sometime this summer, predicts Wayne van Halem, president of the van Halem Group.   That means OMHA should be back to holding hearings at the ALJ level within 90 days as required by law, he says.  “The appeals process has to be timely,” he said. “If the appeals process is timely and Medicare has to hold off...

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...

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...

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...

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....

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...

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...

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...

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...

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...