Administrative Appeals

News & Analysis as of

CFPB Revises Supervisory Appeals Process

As we wrote last week, the CFPB recently published a Fall 2015 Supervisory Highlights which included a summary of changes that have been made to the CFPB’s supervisory appeals process. The original supervisory appeal process...more

CFPB Revises Supervisory Appeals Process

As we wrote last week, the CFPB recently published a Fall 2015 Supervisory Highlights which included a summary of changes that have been made to the CFPB’s supervisory appeals process. The original supervisory appeal process...more

Crude-by-Rail Update: PHMSA Rejects Administrative Challenges to CBR Rule

Despite challenging oil prices and a decrease in the volume of crude oil traveling by rail, recent events have renewed the spotlight on crude-by-rail (CBR) transportation. First, two trains derailed in Wisconsin last weekend...more

AGG Helps Hospice Weather the Perfect Storm of Aggressive Medicare Payment Denials and Administrative Appeal Backlog

Medicare’s implementation of post-payment review through private contractors who are overly aggressive in denying payments, combined with a severe backlog of cases in queue for hearing before an Administrative Law Judge...more

Court Rules that Medicare and Medicaid Payments to Nursing Home Must Continue Pending Jurisdictional Dispute

On October 27, 2015, United States District Judge James S. Moody, Jr. extended a stay of proceedings thereby permitting Bayou Shores SNF, LLC (“Bayou Shores”) to remain viable and continue receiving Medicare and Medicaid...more

Alert: CFPB Releases Ninth Edition of Supervisory Highlights and Announces Changes to Appeals Process

On November 3, 2015, the Consumer Financial Protection Bureau (CFPB) released its ninth edition of Supervisory Highlights, a report which outlines the latest unlawful practices uncovered by the CFPB’s examiners between May...more

OMHA Expands Settlement Conference Facilitation Pilot

The HHS Office of Medicare Hearings and Appeals (OMHA) has announced that it is expanding its Settlement Conference Facilitation pilot’s eligibility criteria to include more pending appeals. As previously reported, this pilot...more

Responding To Challenges In The Merger Review Process, P.2

In our last post, we began speaking about the merger review process and the potential challenges that can come up for companies. One particularly aspect of the review process that can be a sticking point is the period after...more

Nexen’s Fracking Water License has Run Dry - First Nation Prevails in BC Environmental Appeal Board Decision

First Nation Prevails in BC Environmental Appeal Board Decision By Mike Theroux, Brad Gilmour and Laura Gill In a decision released on September 3, 2015, the British Columbia Environmental Appeal Board granted the appeal of...more

The ERISA Litigation Newsletter - September 2015

Editor's Overview - It has been a little more than one year since the U.S. Supreme Court altered the legal landscape for litigating ERISA breach of fiduciary duty claims relating to the investment in employer stock...more

SEC Proposes Amendments to Rules Governing Administrative Proceedings

The Securities and Exchange Commission appears to be hearing the music. In response to the many voices that have expressed dissatisfaction with the procedures used in SEC administrative hearings, the SEC today issued proposed...more

Plaintiffs’ Misdirected Demand for Documents Fails, and Their Claim for ERISA Civil Penalties Is Dismissed: Boyd v. Sysco...

A federal court dismissed the plaintiffs’ claim to recover civil penalties for failure to provide plan documents requested by the plaintiffs. Boyd v. Sysco Corporation, No. 4:13-cv-00599 (D. S. C. September 3, 2015), provides...more

ERISA: When Does A Claimant Get To “Augment” The Administrative Record?

You already know that judicial review of ERISA claims generally will be limited to the administrative record considered by the claim administrator. But the courts will allow claimants to augment the record if ERISA...more

Health Alert (Australia) - August 31, 2015

In This Issue: -Judgments; Legislation; and Reports -Excerpts from Judgments New South Wales (NSW) 28 August 2015 - Smith v Pennington [2015] NSWSC 1168 The Supreme Court gave judgement for the...more

Getting benefits after you win your case

I have a lot of information on my website, blog posts, and Youtube videos for those injured workers in Nevada who want to represent themselves at hearings.  But it appears that I haven’t addressed an important topic for those...more

Employment Law - August 2015 #2

The Customer Isn't Always Right—Especially When He Harasses Employees: Why it matters - Providing an important reminder about the potential for liability from customers, a new lawsuit was filed against a supermarket...more

CMS Limits Scope of Review for MACs

CMS issued a special edition MLN Matters meant to be effective August 1, 2015. The guidance reflects CMS instructions to Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) regarding the...more

Claims Webinar Series: Contract Terminations

In this presentation: - Termination for Convenience (“T4C’) - Termination for Default (“T4D”) - T4C vs. T4D at a glance - Brief overview of termination appeals - Q & A Please see full...more

Concerted Activity or Insubordination?

With its recent decision in Central States SE and SW Areas, Health & Welfare and Pension Funds, 362 N.L.R.B. No. 155, 203 LRRM 2082 (August 4, 2015), the National Labor Relations Board (“NLRB” or “Board”) has provided another...more

PRRB Releases New Reinstatement Rules

Effective July 1, 2015, the Provider Reimbursement Review Board (PRRB or Board) has promulgated new rules regarding the reinstatement and withdrawal of appeals before the Board. The most significant change is a new rule...more

Recent trends involving the L-1 Visa category for intra-company transferees

This article is the second in a two-part series involving the L-1 visa category for intra-company transferees. The previous article provided an overview of the L-1 visa category and suggested strategies to maximize its use...more

Connecticut General Assembly Enacts Reforms To Medicaid Audit Statute

For many years, Medicaid providers have vigorously protested the Connecticut Department of Social Services' (DSS's) audit process and methodology, which many believe to be unfair and unnecessarily punitive. As a result, in...more

RLUIPA Suit Looms After Controversial Connecticut Church Denial

The Danbury Zoning Board of Appeals denied a church’s application for variances to develop an 18-acre parcel with a house of worship and priest residence. Now, Danbury could join the list of Connecticut municipalities that...more

Despite 1st Administrative Appeal, CFPB Seeks Out Courts

On June 4, 2015, Consumer Financial Protection Bureau Director Richard Cordray issued a decision in the first appeal of a CFPB administrative proceeding. The appeal to Director Cordray followed the CFPB's first administrative...more

CFPB Issues Final Decision in In Re: PHH Corp.: First Agency Decision in Contested Administrative Proceeding

Earlier this month, the Consumer Financial Protection Bureau (CFPB) issued the Director’s final decision in the CFPB’s enforcement action against PHH Corp. (PPH). The decision is the agency’s first ruling in a contested...more

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