Tag Archives: Office of Medicare Hearings and Appeals

Medicare Appeals Settlement Program Expanded

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.…

CMS Final Rule Streamlines Appeals Process

The Centers for Medicare and Medicaid Services (CMS) recently issued a Final Rule to streamline and address the substantial backlog of Medicare administrative appeals at the Administrative Law Judge (ALJ) and Departmental Appeals Board (DAB)/Medicare Appeals Council levels.

Among other changes to the appeals process, the Final Rule:

  • Permits the designation of Medicare Appeals Council decisions as precedential, in order to provide clarity
  • Gives attorney adjudicators certain authority that had been previously reserved to the ALJs, including the authority to decide appeals that can be determined without a hearing, to

Appeal Filed in Case Ordering HHS to Reduce Backlog of ALJ Appeals

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 Circuit, Case No. 17-5018).  In his Memorandum Decision filed December 5, 2016, Judge Boasberg had ordered HHS to achieve a 30% reduction in the current backlog of cases pending at the ALJ level by December …

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