Court rules for AHA in Medicare appeals backlog case

A federal court today ruled in favor of the AHA and its member hospital plaintiffs, and reinstated a mandamus order establishing annual deadline-based targets for reducing the backlog of Medicare appeals at the Administrative Law Judge level. The order by U.S. District Judge James Boasberg requires that the Department of Health and Human Services achieve the following reductions from its own currently projected fiscal year 2018 backlog of 426,594 appeals: a 19 percent reduction by the end of FY 2019; a 49 percent reduction by the end of FY 2020; a 75 percent reduction by the end of FY 2021; and elimination of the backlog by the end of FY 2022.
 
“The AHA is extremely pleased that Judge Boasberg recognized the need to reimpose a time-based mandamus remedy for reducing the Medicare appeals backlog, which is what the AHA and plaintiff hospitals had originally requested,” said AHA General Counsel Melinda Hatton. “The court’s mandamus order will serve to keep HHS accountable in reducing the backlog.”
 
The order also requires HHS to file quarterly status reports beginning Dec. 31. At an October hearing, government counsel had argued that court-ordered reduction targets are now unnecessary because of additional agency funding to expand adjudicatory capacity and the reduced volume of Recovery Audit Contractor-related appeals currently entering the system.
 
“As this time around the Government agrees that recent funding has made compliance possible within four years, the Court will impose such a deadline,” today’s opinion from Judge Boasberg states.