HHS Enjoined from Enforcing Self-Disallowance Regulation


On August 6th, the U.S. District Court for the District of Columbia enjoined HHS (along with the PRRB and CMS’s Medicare contractors) from applying HHS’s “self-disallowance” regulation to any appeals filed on the basis of an untimely NPR.

The court’s injunction unlocks the door for certain provider appeals that the self-disallowance regulation had facially barred. The injunction was entered in three related Medicare reimbursement appeals. The appeals were filed on behalf of a group of more than 40 hospitals, each seeking reversal of PRRB dismissals for lack of jurisdiction for asserted noncompliance with the self-disallowance regulation. The hospitals may now pursue their underlying reimbursement claims involving challenges to Medicare’s outlier supplemental payment program (approximately US$90 million) and the rural floor budget neutrality adjustments (approximately US$20 million.)

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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