Court rules HHS' proposed strategy to relieve Medicare appeals backlog 'inadequate'

The U.S. District Court for the District of Columbia concluded HHS' proposed strategies to alleviate the Medicare appeals backlog are insufficient and so will allow the American Hospital Association's litigation against HHS to proceed, according to Lexology.

In May 2014, AHA, BaxterRegionalMedicalCenter in Mountain Home, Ark., Covenant Health in Knoxville, Tenn., and Rutland (Vt.) RegionalMedicalCenter filed suit against HHS to compel the agency to meet the statutory deadlines for review of Medicare claims appeals. In February, a federal appeals court remanded the case to the U.S. District Court of D.C. after AHA's legal claims were initially dismissed in 2014.

The district court issued a ruling Sept. 19 that found HHS' proposed administrative and legislative changes to the Medicare appeals process inadequate to address the scope of the problem. The court noted the recovery audit contractor program recovered billions of dollars in improperly paid funds, but has also caused the current backlog of Medicare appeals.

But district judges also determined that forcing HHS to comply with statutory appeals deadlines would likely require "drastically limiting the scope" of the RAC program.

In absence of a "magic wand" to eliminate the current appeals backlog, the court ordered the plaintiffs and defendant to appear for a status conference on Oct. 3 to discuss how to proceed.

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