HHS gives update on efforts to reduce backlog of Medicare appeals

As required by a judge's ruling in a lawsuit brought by the AHA and its member hospital plaintiffs, the Department of Health and Human Services recently provided an update on its progress reducing the backlog of Medicare appeals at the Administrative Law Judge level. HHS said there were 417,198 appeals pending at the end of the fourth quarter of 2018 compared to more than 886,000 appeals pending in 2015. In addition, Recovery Audit Contractor appeals declined from nearly 50,000 at the end of 2015 to 774 in 2018.
 
In November, a federal court ruled in favor of the AHA and reinstated a mandamus order establishing annual deadline-based targets for reducing the backlog of Medicare appeals at the ALJ level. The order by U.S. District Judge James Boasberg required HHS achieve the following reductions from its own 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. HHS did not appeal the judge's ruling in the case.