The Office of Medicare Hearings and Appeals (OMHA) has announced the expansion of their Settlement Conference Facilitation (SCF) program. SCF is a dispute resolution process for Medicare appeals that provides for payments as percentage of the Medicare approved amount. The percentage is negotiated during a telephone settlement conference utilizing a mediation facilitator. Utilizing dispute resolution processes such as SCF will be very important in helping to reduce a very significant backlog of Medicare appeals, which the government estimates would take OMHA at least eleven years to process.
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Backlog
Fifth Circuit Reinstates Provider’s Collateral Challenge to the Medicare Appeal Process
On March 27, 2018, the United States Court of Appeals for the Fifth Circuit held that a health care provider can seek an injunction in federal court against recoupment by Medicare of alleged overpayments despite not exhausting its administrative appeal remedies, in part because the current delay in scheduling of hearings before an Administrative Law Judge could cause the provider to go out of business before it has an opportunity to exhaust its administrative challenge of the recoupment. This decision could provide a template for other providers facing significant Medicare recoupment demands amidst the “colossal backlog” in Medicare appeals to delay such recoupments until their appeals receive a hearing.
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Appeal Filed in Case Ordering HHS to Reduce Backlog of ALJ Appeals
By Robinson+Cole's Health Law Group on
The Secretary of the U.S. Department of Health & Human Services (HHS) has appealed a ruling by United States District Court Judge James E. Boasberg that had required HHS to make substantial reductions in its current backlog of cases pending before Administrative Law Judges (ALJ) (Notice of Appeal, U.S. Court of Appeals, District of Columbia…