HHS Ordered To Eliminate Medicare Appeals Backlog By 2021

By Kevin Bradberry on January 25, 2017 Posted in Uncategorized

On January 4, 2017, the U.S. District Court for the District of Columbia rejected a request by the Secretary of HHS asking the court to reconsider its decision that requires HHS to eliminate the backlog of Medicare claims appeals pending at the Office of Medicare Hearings and Appeals (OMHA) by 2021. While “not unsympathetic to [the … Continue Reading

Medicare Advantage Plan Arbitration Clauses Preempted by Medicare Appeals Process

By Robert M. Wolin on September 15, 2016 Posted in Uncategorized

The Arizona Supreme Court, in an interesting case involving a Medicare-related coverage dispute between a Medicare Advantage plan administrator, United Behavioral Health (UBH), and two inpatient psychiatric care providers, held that the Medicare administrative appeals process preempts the arbitration language contained in the UBH provider agreements. The court also remanded the case back to the … Continue Reading

I’ll Gladly Pay You 10 Years From Today for Care Already Provided

By Robert M. Wolin on April 14, 2016 Posted in Uncategorized

Most providers whose claims have been determined to be improper by the Recovery Audit Contractors (RACs) under the Medicare Recovery Audit Program have discovered that the appeals backlog “is incontrovertibly grotesque.” Two Courts of Appeals have recently acknowledged that the Office of Medicare Hearings and Appeals (OMHA) has a 10-year backlog of more than 800,000 … Continue Reading