Administrative Appeals

News & Analysis as of

CFPB Suffers First Official CID Challenge

On April 21, 2016, Judge Richard J. Leon of the United States District Court for the District of Columbia ruled on the first judicial challenge to the Consumer Financial Protection Bureau’s (“CFPB,” or “Bureau”) authority to...more

The Continuing Saga Surrounding Magnet Sets: Proof of the CPSC's Determination to Eradicate Hazards to Children

The Consumer Product Safety Commission (CPSC) has made it very clear over the last several years that it takes hazards associated with rare earth magnet sets very seriously, primarily because the hazards affect children. Rare...more

D.C. Circuit Appears Poised to Overturn First CFPB Enforcement Action to Reach the Court: Five Key Takeaways From Yesterday’s Oral...

Major financial firms almost never litigate with their regulators. As a result, regulators often take aggressive enforcement positions with little fear of judicial scrutiny. That’s been especially true for the Consumer...more

D.C. Circuit Judge Expresses Concern That CFPB Concentrates “Huge Power” in Single Director

Yesterday’s oral argument in the CFPB v. PHH Corporation appeal included sharp questioning about the constitutionality of the Consumer Financial Protection Bureau’s (CFPB) single-director structure, which the parties agreed...more

New SSA Policy Makes It Easier to Understand Why Your Special Needs Trust Was Rejected

The Social Security Administration (SSA) recently issued an Emergency Message to all personnel requiring workers to specifically inform Supplemental Security Income (SSI) applicants or beneficiaries of the reasons a special...more

Appeals Procedures for Tax Court Cases

The Internal Revenue Service (Service) on March 23, 2016, issued Revenue Procedure 2016-22 which clarifies and describes the practices for the administrative appeals process in cases docketed in the United States Tax Court...more

Medicare Appeals 10-Year Backlog: D.C. Circuit Signals Enough is Enough

Issued within a month of one another, two cases regarding the Medicare appeals backlog reached opposite conclusions, providing a circuit-split. The first case from the D.C. Circuit, signaling a major shift toward judicial...more

Office of Medicare Hearings and Appeals Launches Settlement Conference Facilitation Pilot for Medicare Part A Claims

The HHS Office of Medicare Hearings and Appeals (“OMHA”) recently launched Phase III of the Settlement Conference Facilitation (“SCF”) Pilot to help resolve outstanding Medicare Part A appeals. The SCF program is one of...more

Proposed Enrollment Rule Changes - de Facto Exclusion?

Proposed rules, touted as enhancing the provider enrollment process, would provide CMS with sanction authority that closely parallels the OIG’s exclusion authority. Under the proposed rules, CMS would have expanded bases to...more

Environmental Notes - March 2016

U.S. Supreme Court to Decide Whether Jurisdictional Determinations May be Appealed - The U.S. Army Corps of Engineers determines the presence or absence of wetlands and other “waters of the United States” on a...more

U.S. Supreme Court to Decide Whether Jurisdictional Determinations May be Appealed

The U.S. Army Corps of Engineers determines the presence or absence of wetlands and other “waters of the United States” on a particular site by issuing a “jurisdictional determination” (JD). A JD is of great significance to...more

FERC Signals Intention to Closely Scrutinize Late Interventions

Movants must clear high hurdle once parties reach settlement in principle. On March 9, the Federal Energy Regulatory Commission (FERC or the Commission) issued an order in Maritimes & Northeast Pipeline, LLC (Maritimes...more

Also In The News - Health Headlines - March 2016

OMB to Review Medicare Appeals Procedures – The Office of Information and Regulatory Affairs (“OIRA”) within the Office of Management and Budget (“OMB”) is set to review new Medicare appeals process proposed rulemaking. ...more

Federal Court finds “Systemic Failure” in Processing of Administrative Appeals for Medicare Reimbursement Claims

A win for efficiency: The AHA suit may force shorter adjudication times for Medicare administrative appeals. In 2014, the American Hospital Association (AHA), along with three hospital systems, filed suit against the U.S....more

Congressional Budget Office Issues Cost Estimate Report on Medicare Appeals Reform Act

On February 16, 2016, the Congressional Budget Office (CBO) issued a cost estimate report on the Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015 (S. 2368). The purpose of the Act is to address the...more

Court Rules Hospitals Must Exhaust HHS Administrative Appeals Process for Medicare Advantage Out-of-Network Payment Dispute

According to a Georgia federal district court ruling issued on February 11, 2016, a group of hospitals must exhaust their out-of-network Medicare Advantage (MA) payment dispute through the Department of Health and Human...more

HHS May Be Forced to Meet Statutory Deadlines for ALJ Appeals

On February 9, 2016, a three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit reversed a district court’s dismissal for lack of jurisdiction in the American Hospital Association v. Burwell case. ...more

ERISA — 10th Circuit: What Happens When a “Procedural Irregularity” Occurs in an Appeal Denial?

You know that procedural irregularities in an appeal denial of a claim for ERISA-governed benefits can change the standard of review from arbitrary and capricious to de novo review. But not all the time. The claimant should...more

Health Alert (Australia) - February 1, 2016

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: Commonwealth. Administrative Appeals Tribunal 22 January 2016 - JLSP and Innovation Australia [2016] AATA 23 This...more

Cuozzo Speed Technologies, LLC v. Lee

The Supreme Court on Friday granted certiorari to review the Federal Circuit's decision that the U.S. Patent and Trademark's Patent Trial and Appeal Board was entitled to perform claim construction in inter partes review...more

USPTO Implementation of AIA Does Not Violate Due Process: Federal Circuit Affirms the PTAB Panel Determining Institution of an IPR...

In Ethicon Endo-Surgery, Inc. v. Covidien LP, a 2-1 panel split of the Federal Circuit held that neither the American Invents Act (“AIA”) nor the Constitution precludes the same panel of the Patent Trial & Appeal Board...more

FCC Wireless Shot Clock Trumps Complex Local Processes, Says First Circuit While Addressing Section 332 “Final Action” Requirement

On Jan. 8, 2016, in Global Tower Assets, LLC v. Town of Rome, the U.S. Court of Appeals for the First Circuit held that a wireless permit applicant must go through all administrative appeals required by local law before there...more

National Restaurant Association Challenges Minimum Wage Law

Earlier in 2015, the New York Legislature rejected a proposal to raise the minimum wage to $11.50 in the Big Apple, and to $10.50 in the rest of the state.  Governor Andrew Cuomo utilized his ability to direct the labor...more

Supreme Court to Decide if Army Corps Initial Jurisdictional Determination to Regulate Wetlands Under CWA is Ripe for Judicial...

By Andrew H. Perellis, Patrick D. Joyce, and Craig B. Simonsen The Supreme Court of the United States (SCOTUS) agreed on Friday to review an important Clean Water Act (CWA) decision issued by the Eighth Circuit in Hawkes Co.,...more

U.S. Supreme Court Agrees to Decide Important Case Affecting Development in Wetlands

A critical part of the permitting process for many development projects is obtaining federal and state wetland permits. The key wetland authorization is usually a Section 404 permit from the U.S. Army Corps of Engineers...more

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