Statement on Appeals Court Decision on AHA ALJ Delay Lawsuit Upholding Compliance with Statutory Deadlines

Melinda Hatton

Senior Vice President and General Counsel

American Hospital Association

February 9, 2016

Today’s Appeals Court decision moves the hospital field closer to getting relief for timely reviews of Medicare claims denials, which they asked for more than a year ago. Through its ruling, the court recognized the problem continues to worsen and urges the lower court to issue relief unless the Department of Health and Human Services and Congress act in a timely way to resolve the problem.

Specifically, it urges the lower court to provide the relief hospitals are requesting unless Congress and the agency make meaningful progress to address the backlog of appeals by the close of the next appropriations cycle.

The appeals court today affirms that hospitals simply cannot afford to have billions of dollars that are needed for patient care tied up indefinitely in the appeals process. Today’s decision confirms that the agency has a clear duty to comply with the congressionally mandated deadlines and that the statute gives hospitals a corresponding right to demand compliance. And, it refutes attempts by the agency to excuse compliance because of the Recovery Audit Contractor program, noting that congressional mandates trump discretionary decisions.

We fully expect that the lower court to rule in favor of hospitals when it reconsiders the case unless HHS and Congress makes meaningful progress to resolve the backlog.

###

About the AHA

The AHA is a not-for-profit association of health care provider organizations and individuals that are committed to the health improvement of their communities. The AHA is the national advocate for its members, which include nearly 5,000 hospitals, health care systems, networks, other providers of care and 43,000 individual members. Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends. For more information, visit the AHA website at www.aha.org.