News: District court denies motion to delay proceedings in appeals backlog case

CDI Strategies - Volume 10, Issue 42

The U.S. District Court for the District of Columbia denied the Department of Health and Human Services’ claim to delay proceedings in an appeals backlog case until September 30, 2017, according to a civil action notice released by the Court.

In 2014, the American Hospital Association asked the court to issue a writ of mandamus to compel the HHS to process their long-pending claim-reimbursement appeals in accordance with statutory timelines. The Court denied the AHA’s request, believing the matter best left to the political process. However, the Court of Appeals disagreed, holding that the Court has jurisdiction to grant mandamus relief.

In response, the HHS filed a motion to stay the proceedings to allow the department to “move forward on various administrative and legislative efforts designed to tackle the backlog of reimbursement appeals.” Once again, the Court was reluctant to intervene, but the backlog and delays have only worsened in two years—for the federal fiscal year (FY) ending September 2015, more than 884,000 Medicare claims were awaiting adjudication before Administrative Law Judges, according to an article released by the Office of Medicare Hearings and Appeals (OMHA). Therefore, the Court ultimately decided to deny the HHS’s motion.

U.S. District Judge James Boasberg reviewed the two categories of actions presented by HHS:

  1. Administrative actions including estimates of the effect on the backlog
  2. Legislation to reform the appeals process and provide the agency with additional funding

The HHS’s proposed administrative fixes would result in 50% fewer backlogged OMHA appeals in fiscal year 2020, according to Boasberg. However, the OMHA backlog will continue to grow every year between FY 2016 and FY 2020, from roughly 757,090 to 1,003,444 appeals, according to the Court statement.

“Significant progress toward a solution cannot simply mean that things get worse more slowly than they would otherwise,” says Boasberg. 

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