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District Court Orders HHS to Eliminate Medicare Appeals Backlog

On Monday, in an opinion issued by Judge James Boasberg, the U.S. District Court for the District of Columbia ordered the Department of Health and Human Services (HHS) to clear its backlog of Medicare reimbursement appeals by the end of 2020. Judge Boasberg’s opinion granted a motion for summary judgment filed by the American Hospital Association in American Hospital Association v. Burwell (14-851).

Commending the AHA for offering a “thoughtful and reasonable four-year plan,” Judge Boasberg’s opinion adopts the deadlines and mandatory-percentage reductions put forth by the AHA; 30% reduction by December 31, 2017, 60% reduction by December 31, 2018, 90% reduction by December 31, 2019 and 100% by December 31, 2020. The final point in AHA proposed plan, a requirement to grant default judgment in favor of claimants for appeals still pending at the ALJ level on January 1, 2021 without a hearing for more than one calendar year, raised concerns for the court and was not included in the order.  The judge’s order requires HHS file status reports with the court every 90 days.

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