Tag: American Hospital Association (AHA)

WASHINGTON – The American Hospital Association has urged the U.S. Department of Justice to establish a task force to conduct False Claims Act investigations into commercial health insurance companies that are found to routinely deny patients access to services and deny payments to health care providers.  The AHA’s letter follows a recent report from the Office of Inspector General that found Medicare Advantage organizations are violating their obligation to cover the...

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...

YARMOUTH, Maine - The American Hospital Association's lawsuit against the Department of Health and Human Services over a massive appeals backlog has been ping-ponging between the U.S. District Court for the District of Columbia and the D.C. Circuit Court since it was first filed in 2014. The latest ruling, issued Aug. 11, directed a federal judge to take a closer look at whether it's actually feasible for HHS to clear the backlog by 2021, as previously ordered. “I think the D.C....

NEW YORK - The D.C. Circuit on Aug. 11 ordered a federal judge to take a deeper look at whether or not the U.S. Department of Health and Human Services can clear a backlog of about 600,000 appeals by 2021, while still protecting taxpayer dollars, according to Law360. The ruling is a setback for the American Hospital Association, which has been fighting HHS in court over the backlog for several years. The D.C. Circuit, in a 2-1 ruling, said the judge didn't properly evaluate HHS's assertion...

WASHINGTON - A federal court has ordered the U.S. Department of Health and Human Services to solve the backlog at the Administrative Law Judge level, according to an update from The VGM Group. In a decision handed down Sept. 19, the court denied HHS's request to put litigation with the American Hospital Association on hold until Sept. 30, 2017. “Between fiscal years 2010 and 2014, the number of appeals filed at step three grew 936%, from 41,733 to 423,534,” noted the D.C. court. “Because...

WASHINGTON - Even though the American Hospital Association (AHA) lost its bid to get a court to intervene in a huge backlog of appeals of Medicare claims, the lawsuit keeps the controversial program in the spotlight, industry stakeholders say. The U.S. District Court for the District of Columbia ruled in December not to require the Department of Health and Human Services (HHS) to meet statutory deadlines for timely review of claim denials. The judge said that Congress, not the court, should take...