ALJ Delay Lawsuit: Remedy Opinion and Order

Memorandum Opinion

This case is now before the Court for a third time, following a second remand from the D.C. Circuit. Plaintiffs here are the American Hospital Association and three other regional hospitals and health-care systems. Fed up by the delays in the administrative-appeals process for Medicare-reimbursement claims, they filed this suit in May 2014. Plaintiffs sought mandamus to compel the Secretary of the Department of Health and Human Services to comply with the statutory deadlines the Medicare Act imposes on the appeals process. See ECF No. 1 (Complaint). The Circuit initially instructed this Court to weigh the equities to determine whether mandamus should issue. After it did so and concluded that the writ was appropriate, the Circuit reversed and remanded the matter for this Court to make a threshold determination of whether it was possible for the Government to comply with the mandamus order. See Am. Hosp. Ass’n v. Price (AHA V), 867 F.3d 160, 161 n.1 (D.C. Cir. 2017). As this time around the Government agrees that recent funding has made compliance possible within four years, the Court will impose such a deadline.

Order

For the reasons set forth in the accompanying Memorandum Opinion, the Court ORDERS that:

1. Defendant’s Motion for Summary Judgment is DENIED;
2. Plaintiffs’ Cross-Motion for Summary Judgment is GRANTED;
3. Defendant must achieve the following reductions from the currently projected FY 2018 backlog of 426,594 appeals: a 19% reduction by the end of FY 2019; a 49% reduction by the end of FY 2020; a 75% reduction by the end of FY 2021; and elimination of the backlog by the end of FY 2022; and
4. Defendant must file status reports beginning on December 31, 2018, and continuing every quarter thereafter.

IT IS SO ORDERED.