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Health Care Providers › Appeals › Administrative Law Judge (ALJ)

Husch Blackwell LLP

Hospice Insights Podcast - Hospice Audit Updates: Hospices Fare Well in Federal Court

Husch Blackwell LLP on

Increasing audit activity combined with certain decreasingly favorable audit appeal outcomes has resulted in hospices appealing audit results beyond the administrative law judge phase and into federal court. In this episode,...more

Health Care Compliance Association (HCCA)

Provider Wins $2M Appeal at ALJ Over Modifier 25, Random Sample

Health Care Compliance Association (HCCA) on

Report on Medicare Compliance 30, no. 11 (March 22, 2021) - A cancer center has won its appeal of $2 million in Medicare claim denials in a case about modifier 25 and the extrapolation of an overpayment. Problems with the...more

Herbert Smith Freehills Kramer

Fifth Circuit Joins Circuit Split Upholding Bankruptcy Court Jurisdiction to Hear Social Security Claims: Case Has Impact for...

Herbert Smith Freehills Kramer on

In a case that could impact health care bankruptcies, where jurisdiction over Medicaid and Medicare claims in bankruptcy are often disputed, the Fifth Circuit, in In re Benjamin v. U.S. Social Sec. Admin., Case No. 18-20185,...more

K&L Gates LLP

K&L Gates Triage: Medicare Overpayment Recoupment Halted by Court

K&L Gates LLP on

In a recent decision, the Northern District of Texas, Dallas Division, granted a health care provider a preliminary injunction to prevent the Centers for Medicare & Medicaid Services ("CMS") from withholding Medicare payments...more

Sheppard Mullin Richter & Hampton LLP

CMS Rolls Out Provider Appeals Settlement Efforts

Sheppard Mullin Richter & Hampton LLP on

This year CMS is rolling out two new programs aimed, finally, at helping to settle certain types of pending provider reimbursement appeals. The programs are the Low Volume Appeals Initiative and Settlement Conference...more

Baker Donelson

Court Finds Jurisdiction to Bar Recoupment Associated with Pending Claims Appeal

Baker Donelson on

On March 27, 2018, the United States Court of Appeals for the Fifth Circuit published an opinion that provides Family Rehabilitation, Inc. (Family Rehab) a second chance to postpone recoupment of about $7.6 million in...more

Parker Poe Adams & Bernstein LLP

Appeals Court Win Gives Providers Another Way to Challenge Medicare Appeals Backlog

Parker Poe Adams & Bernstein LLP on

A federal appeals court issued a significant ruling last week in relation to the ongoing backlog of Medicare claims appeals. It potentially gives providers a new way to seek relief when Medicare comes to collect money that an...more

McDermott Will & Schulte

Medicare Appeals Backlog: A Setback and New Opportunities for Providers

McDermott Will & Schulte on

As of June 2017, the Office of Medicare, Hearing and Appeals (OMHA) had 607,402 appeals pending with a current estimated wait time of three years for an Administrative Law Judge to process a provider’s appeal. At this rate,...more

Baker Donelson

Court of Appeals Reverses D.D.C. Order Requiring HHS to Eliminate Medicare Appeals Backlog by December 31, 2020

Baker Donelson on

Hopes were dashed for sooner relief from the backlog of Administrative Law Judge (ALJ) appeals. With the backlog of Medicare reimbursement appeals steadily growing, a reversal by the U.S. Court of Appeals for the District of...more

BakerHostetler

HHS Ordered To Eliminate Medicare Appeals Backlog By 2021

BakerHostetler on

On January 4, 2017, the U.S. District Court for the District of Columbia rejected a request by the Secretary of HHS asking the court to reconsider its decision that requires HHS to eliminate the backlog of Medicare claims...more

Latham & Watkins LLP

Recent Developments in Litigation Challenging the Medicare Appeals Delays: Is Victory Likely for Medicare Providers?

Latham & Watkins LLP on

On September 19, 2016, the U.S. District Court for the District of Columbia (D.D.C.) refused to stay a highly anticipated case seeking to force the government to comply with statutory deadlines governing the Medicare appeals...more

Polsinelli

OMHA Expands Settlement Conference Facilitation Program to Part A Appeals: 10 Things to Know

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On Feb. 25, 2016, the Office of Medicare Hearings and Appeals (OMHA) conducted a teleconference to address Phase III of the Settlement Conference Facilitation (SCF) project, which also became effective on Feb. 25, 2016. SCF,...more

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