Court rejects HHS request to reconsider order to eliminate appeals backlog

A federal judge yesterday rejected a request by the Department of Health and Human Services that he reconsider requiring the agency to eliminate within four years the Medicare claims appeals backlog pending at the administrative law judge level. A Motion to Reconsider “is not a vehicle to present a new legal theory that was available prior to judgment or to reargue previously raised theories,” wrote U.S. District Court Judge James Boasberg, rejecting HHS’s argument that the order would force the Secretary to pay pending claims without regard to their merit, contrary to the Medicare statute. “[D]efendant’s argument is not new; it was twice urged in prior briefing.” In a case brought by the AHA and three member hospitals, Boasberg last month ordered the agency to reduce the backlog of cases 30% by Dec. 31, 2017; 60% by Dec. 31, 2018; 90% by Dec. 31, 2019; and 100% by Dec. 31, 2020; and to file status reports with the court every 90 days. “This latest decision from the court sends another clear and unmistakable message to HHS that they should focus on implementing real reforms critical to resolving the backlog, including fundamental changes to the Recovery Audit Contractor program,” said AHA General Counsel Melinda Hatton.