Administrative Appeals

News & Analysis as of

Court: USCIS should consider ‘life experience’ for specialized knowledge L-1B visa

In holding that cultural traditions and life experience can be considered “specialized knowledge” for purposes of obtaining an L-1B intracompany transferee visa, a United States appeals court rejected the proposition that a...more

CMS Provides for Greater MAC Involvement in ALJ Hearings

CMS recently issued Transmittal 543, Change Request 8501 in which it instructs Medicare Administrative Contractors (MACs) to, among other things, defend their medical review decisions through the Administrative Law Judge...more

Post-Therasense IC Alive and Kicking at the Federal Circuit

Apotex Inc. v. UCB, Inc. - After finding that a patent owner had made several misrepresentations to the Patent and Trademark Office (PTO) during prosecution, the U.S. Court of Appeals for the Federal Circuit concluded...more

When a Win is Not a Win- Stay Orders

If an injured worker in Nevada successfully convinces a hearing officer to reverse an adjuster's action on a claim, the insurer and/or the employer has the right to file an appeal to an appeals officer. The insurer or...more

CMS Waves Partial White Flag in Appeals of Payment Status Denials

For the last several years, hospitals, on the one hand, and the Centers for Medicare and Medicaid Services and its contractors (collectively, CMS), on the other, have been engaged in a spirited dispute over claims denials for...more

D.C. Circuit Rules That "Exhaustion of Administrative Remedies" Is Not Required For Violations of ERISA’S Statutory Guarantees:...

The U. S. Court of Appeals for the District of Columbia Circuit has joined five other federal circuits to rule that pension plan participants need not exhaust a plan’s internal remedial procedures before they file suit in...more

Self-Insured Health Plans May Be Required To Allow Health Care Providers Access To Their Claims And Appeals Process

In a precedent-setting case, a district court in the Northern District of Illinois recently ruled that in-network chiropractors were considered “beneficiaries” under the Employee Retirement Income Security Act of 1974 (ERISA)...more

Is the Claimant entitled to attorney fees when the government asserts an unreasonable position?

In Tobeler v. Colvin, 2014 DJDAR 4845 (2014), the United States Court of Appeal for the Ninth Circuit overturned the trial court’s decision rejecting a claim for attorney fees. ...more

Royal Charter Appeal Dismissed

On 18 March 2013, the government, following the recommendations of the Leveson report, proposed a Royal Charter on press regulation. The Press Standards Board of Finance Limited (PressBoF), the body charged with raising a...more

Bakorp: Appeal Dismissed For Failure To Comply With Large Corporations Rules

In Bakorp Management Ltd. v. The Queen (2014 FCA 104), the Federal Court of Appeal upheld a decision of the Tax Court dismissing the taxpayer’s appeal for failure to comply with the rules relating to objections and appeals...more

Court of Appeals Rules 23-Day Notice Requirement for Third Party Summonses is Mandatory in Tenth Circuit

In Jewell v. U.S., Taxpayer Sam Jewell was the subject of an IRS investigation which resulted in third party summonses being issued to banks located in both the Eastern and Western Districts of Oklahoma. Mr. Jewell challenged...more

Medicare Audit and Appeals: A Study in Utter Dysfunction

Facing a backlog of over 350,000 appeals from payment demands issued by Recovery Audit Contractors (RAC's), the Center for Medicare and Medicaid Services ("CMS") has effectively given up and announced that its Office of...more

Third Court of Appeals Invalidates City’s Civil-Service Appeal Deadline

The Third Court of Appeals has reversed a summary judgment granted to the City of Killeen on the sole ground that a police officer’s administrative appeal to the City’s Civil Service Commission was untimely....more

NC Medicaid Providers, Are You Required to Seek an Informal Appeal Prior to Filing a Contested Case at OAH?

Recently, numerous clients have come to me asking whether they have the right to appeal straight to the Office of Administrative Appeals or whether they have to attend informal appeals first, whether the informal appeal is...more

OIG Reports on The First Level of the Medicare Appeals Process

The HHS Office of Inspector General (OIG) recently published the results of a study regarding the first level of the Medicare Parts A and B appeals process, or redeterminations, for years 2008 through 2012. The report...more

Substantial Evidence Test Applies In Administrative Appeal From University Of California’s Decision To Terminate Employee

A University of California employee sought review of the University’s decision to terminate his employment because he violated the policy against workplace violence or threats. The employee asserted that an independent...more

The Administrative Appeal Office (AAO) Sustains An Appeal Related To An EB-1 (C) Multinational Executive Or Manager Application

In a decision dated June 13, 2013 the Administrative Appeal Office (AAO) found that USCIS’ Nebraska Service Center’s denial of an EB-1 (C) Multinational Executive/Manager application was deficient as it was based upon...more

CMS Revises Part B Billing Policy for Unnecessary Inpatient Admissions

For many years, CMS policy has been that, if an inpatient admission was denied for medical necessity reasons, the hospital could bill under Part B for only a limited set of services that, significantly, did not include...more

8th Circuit – Expressing Intent to Appeal in the Future Does Not Constitute an “Appeal.”

How does an ERISA claimant start an administrative appeal? Can a mere request for medical records, and a reference to an “appeal in the future tense,” trigger the appeal? No....more

U.S. Supreme Court Holds Equitable Tolling Doctrine Does Not Apply To Administrative Appeal Deadline

On January 22, 2013, the U.S. Supreme Court issued a unanimous decision in Sebelius v. Auburn Regional Medical Center, 568 U.S. _____ (2013), holding that hospitals cannot appeal Medicare inpatient reimbursement...more

Are Hernias Ratable?

Inguinal hernias are common work-related injuries for men, often caused by increased abdominal pressure during heavy lifting. According to the November/December 2012 AMA Guides Newsletter, men have a 27% lifetime risk of an...more

Supreme Court Decides Kloeckner v. Solis

On December 10, 2012 the U.S. Supreme Court issued a unanimous decision in Kloeckner v. Solis holding that “[a] federal employee who claims that an agency action appealable to the MSPB violates an antidiscrimination statute...more

Eighteen Counties Will Send Out Revaluation Notices in 2013

Counties in North Carolina are required to revalue real property every eight years; however, some counties chose to do so in shorter intervals. According to the North Carolina Department of Revenue, eighteen counties are set...more

Illinois Supreme Court to Consider If Mailbox Rule Applies to Administrative Appeal From Workers Comp Commission

Our preview of the civil cases to be heard by the Illinois Supreme Court during the upcoming January term concludes with Gruszeczka v. The Illinois Workers' Compensation Commission. Gruszeczka poses an important question:...more

Supreme Court Clarifies Appeals Rights For Federal Employees

On December 10, 2012, the Supreme Court handed down a critical victory to federal employees in a highly technical case. This decision now gives federal employees a simpler and less confusing process for appealing...more

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