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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