• AHA Sues over Delays in Appeals Process
  • May 30, 2014 | Authors: Leslie J. Levinson; Michaela ("Kayla") Tabela
  • Law Firms: Edwards Wildman Palmer LLP - New York Office ; Edwards Wildman Palmer LLP - Boston Office
  • On May 22, 2014, the American Hospital Association (AHA) and three member hospitals filed a lawsuit against Secretary Kathleen Sebelius, in her capacity as the Secretary of the U.S. Department of Health and Human Services (HHS), in the U.S. District Court for the District of Columbia to compel HHS to meet the statutory deadlines for the administrative review of denials of claims for Medicare reimbursements.

    In late 2013, the HHS Office of Medicare Hearings and Appeals (OMHA) issued a memorandum explaining that it would be suspending the assignment of most new requests for Administrative Law Judge (ALJ) hearings for the next two years due to a massive backlog of appeals and a shortage of ALJs.

    In their complaint, the AHA, Baxter Regional Hospital, Inc. (Mountain Home, Arkansas), Covenant Health (Knoxville, Tennessee), and Rutland Hospital, Inc. (Rutland, Vermont) contend that the lengthy delays in the Medicare appeals process are causing severe financial harm to Medicare providers. Baxter Regional Hospital claims that it has approximately $4.6 million tied up in the Medicare appeals process, with more than $1.7 million pending at the ALJ level. Similarly, Covenant’s Hospitals have more than $7.6 million in system-wide claims pending in the Medicare appeals process, approximately $6.6 million of which is pending at the ALJ level, and Rutland Hospital currently has approximately $588,000 tied up in the Medicare appeals process, of which approximately $554,000 is pending at the ALJ level.