Administrative Appeals

News & Analysis as of

California: Cal/OSHA Transitions to Electronic Case Management

California employers will soon be able electronically manage California Occupational Safety and Health Appeals Board ("OSHAB") cases...more

District Court Denies Stay in Litigation Over Medicare Appeals Backlog

On September 19, 2016, the U.S. District Court for the District of Columbia rejected a request by HHS to stay proceedings in litigation brought by the American Hospital Association and several providers seeking to compel the...more

Leaving a Tart Taste in One Processor’s Mouth: Court Dismisses Claims of a Plaintiff Subject to the Tart Cherry Order

Agricultural law can often be complicated, but it is not always this "tart." Burnette Foods, a tart cherry processor in Michigan, has found itself in an ironic position: it is subject to a law that was enacted with...more

D.C. District Ct Applies Prohibition on Administrative and Judicial Review to IRF PPS Rates

On July 25, 2016, Judge John D. Bates of the United States District Court for the District of Columbia issued a memorandum opinion broadly construing 42 U.S.C. § 1395ww(j) to prohibit administrative or judicial review of a...more

CMS Proposes ACA Marketplace Benefit and Payment Parameters for 2018

CMS has proposed its annual Notice of Benefit and Payment Parameters, which would apply to participation in Affordable Care Act (ACA) Health Insurance Marketplaces for 2018. In particular, the rule proposes revisions to the...more

FDIC on Marketplace Lending, Supervisory Appeals and Communication

The latest regulator attempting to rein in controls on the marketplace lending industry is the Federal Deposit Insurance Corp. (FDIC). Marketplace lending to consumer borrowers generally runs through state-chartered banks....more

PTO Initiates Post-Prosecution Pilot Program

On July 11, 2016, the US Patent and Trademark Office (PTO) announced a new pilot program to enhance after final practice. The Post-Prosecution Pilot Program (P3) combines elements of the Pre-Appeal Request for Review and AFCP...more

You Received a Health Insurance Marketplace Notice from HHS – Now What?

Take a deep breath. The HHS Health Insurance Marketplace Notice (the “Notice”) may seem to be a nuisance, but it does not necessarily mean that you will be subject to employer shared responsibility penalties....more

Accountability and Transition in ICANN’s New gTLD Program

Bringing accountability to the Internet Corporation for Assigned Names and Numbers (ICANN), the little known yet hugely significant global regulator of the Internet domain name system, is always a significant victory. ICANN...more

Tenth Circuit Orders Truck Driver Who Abandoned Trailer on Interstate Highway to be Reinstated with Backpay

Seyfarth Synopsis: The Tenth Circuit held that a trucking company unlawfully retaliated against a truck driver after he abandoned a trailer on a public highway, finding that his actions constituted a protected refusal to...more

A Favorable, New Climate for Challenging Medicare Appeals

Over the past decade, health care providers seeking to challenge Medicare claim denials have faced increasing delays in reaching what many consider the most important step in the Medicare appeals process - a hearing before an...more

[Webinar] Key Cal/OSHA Issues that California Employers Must Understand - July 21st, 4:00 pm EDT

The state of California’s Division of Occupational Safety and Health (DOSH), better known as Cal/OSHA, is perhaps the most aggressive and enforcement heavy approved state OSH program. Cal/OSHA faces many fewer bureaucratic...more

HHS Proposes Significant Changes to ALJ Hearing Procedures

HHS announced a Proposed Rule on July 5, 2016 aimed at reducing the backlog of appeals at the Office of Medicare Hearings and Appeals (OMHA) and Departmental Appeals Board (DAB) for Medicare payment and coverage...more

Wetlands Determinations - Uncertainty for the Clean Water Rule?

On May 31, 2016, the United States Supreme Court issued its decision in United States Army Corps of Engineers v. Hawkes Co., Inc. holding that approved judicial determinations as to the presence of wetlands issued by the...more

GAO Issues Recommendations To Improve Medicare Appeals Backlog

On June 9, 2016, the Government Accountability Office (GAO) publicly released a report published May 10, 2016, regarding the continuing challenges surrounding the backlog of the administrative appeals process for Medicare...more

CMS Announces "Pause" in QIO Review of Inpatient Admissions

Last week CMS announced a temporary "pause" in the review of inpatient admissions by the Beneficiary and Family Centered Care Quality Improvement Organizations (QIOs). CMS posted this announcement on its Inpatient Hospital...more

CMS Limits MAC and QIC Scope of Review

Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) should not expand redeterminations and reconsiderations of claims denied on the basis of complex pre–or post–pay payments or automated...more

The Supreme Court Holds that Army Corps’ Jurisdictional Determinations are Final Actions Subject to Judicial Review

On May 31, 2016, in United States Army Corps of Engineers v. Hawkes Co., the US Supreme Court unanimously held that a U.S. Army Corps of Engineers’ (Corps) approved jurisdictional determination (JD) is a final agency action...more

California Environmental Law & Policy Update - June 2016

Environmental and Policy Focus - U.S. Supreme Court allows pre-permit challenges to approved jurisdictional determinations - Allen Matkins - May 31 - In a major new legal development for the Clean Water Act's...more

Supreme Court Sides with Property Owners: Jurisdictional Determination is Reviewable

Seyfarth Synopsis: The Supreme Court decided that Army Corps’ jurisdictional determinations are judicially reviewable. This decision leaves open the question of whether other types of administrative decisions are immediately...more

D.C. Circuit Rejects NLRB's Award of Attorneys' Fees and Expenses in Unfair Labor Practice Cases

The U.S. Court of Appeals for the D.C. Circuit recently rejected the National Labor Relations Board’s attempt to expand the remedies available under the National Labor Relations Act for unfair labor practices. Building on...more

Unanimous Supreme Court Sides With Property Owners In Clean Water Act Row

Introduction - On Tuesday, the U.S. Supreme Court issued an important decision that continues a trend of judicial skepticism toward federal agency efforts to avoid judicial review of agency permitting and related...more

US Supreme Court Holds US Army Corps Clean Water Act Determinations Reviewable

Decision allows landowners to challenge in court a US Army Corps of Engineers’ determination that a property is subject to regulation under the Clean Water Act....more

Supreme Court: Clean Water Act Jurisdictional Determinations Challengeable in Federal Court

The Supreme Court of the United States ruled on May 31, 2016, in United States Army Corps of Engineers v. Hawkes Co., Inc., No. 15-290, slip op., 578 U.S. ___ (2016) that approved jurisdictional determinations (JDs) issued by...more

Supreme Court Allows Challenges to Section 404 Jurisdictional Determinations

U.S. Army Corps of Engineers v. Hawkes Co., Inc., No. 15-290 (May 31, 2016) - Why It Matters: The U.S. Supreme Court unanimously concluded that property owners who are required to obtain Clean Water Act (CWA) Section 404...more

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