AHA, hospitals ask court to compel HHS to meet hearing deadlines

AHA News Now

The AHA and three hospitals today asked a federal court to grant an immediate favorable ruling in their lawsuit to compel the Department of Health and Human Services to meet statutory deadlines for timely administrative review of Medicare claims denials. “HHS has a statutory duty to conduct and conclude an [Administrative Law Judge] hearing . . . within ninety days[, but] has conceded that it is failing to do so and further that its delays are ‘unacceptable,’” the motion for summary judgment states. “[T]his is precisely the kind of case for which the remedy of mandamus exists.” The AHA and the hospitals filed the lawsuit in May to compel HHS to comply with the legal mandate for timely review. In December 2013, HHS announced a moratorium on assigning new health care provider appeals to individual ALJs for at least 24 months, meaning hospital appeals can take three or more years to be heard, let alone decided, tying up billions of dollars in Medicare reimbursement for hospitals.

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