Appeals ALJ

News & Analysis as of

Senate Committee Passes Bill Addressing Medicare Appeals Inefficiencies

On June 3, 2015, the Senate Finance Committee passed an original bill that aims to streamline and improve the Medicare Audit and Appeals Process. The Medicare appeals process has recently faced scrutiny from industry leaders...more

Revision Of Coal Mining Permit By Environmental Group Results In Attorney Fee Award

In Black Mesa v. Jewell, 2015 DJDAR 1050, the United States Court of Appeals for the Ninth Circuit concluded that an environmental group was entitled to an award of attorney fees arising out of their challenge to the Office...more

New USCIS Guidance Has Significant Consequences for H-1B Employers

On April 9, 2015, the Administrative Appeals Office (AAO) of the U.S. Citizenship and Immigration Services (USCIS) issued a precedential decision (Matter of Simeio Solutions, 26 I&N Dec. 542) that significantly impacts U.S....more

Appeals Court upholds FTC order enjoining POM Wonderful claims – with modifications

In a much anticipated opinion, the Court of Appeals for the District of Columbia upheld the vast majority of a Federal Trade Commission order enjoining pomegranate juice maker POM Wonderful from advertising that its products...more

CMS Instructs MACs to Participate in ALJ Hearings

CMS officially added a new Section 3.9 to the Medicare Program Integrity Manual, effective October 27, 2014. These provisions instruct Medicare Administrative Contractors (MACs) to assign a physician to participate at...more

Legal Alert: New York Tax Appeals Tribunal Reverses “Distorted” Knowledge Learning Decision and Provides Guidance for Proving...

On September 18, 2014, the New York State Tax Appeals Tribunal (Tribunal) decided its first combination case addressing the 2007 changes to New York’s combined reporting regime: Matter of Knowledge Learning Corporation and...more

Medicare Beneficiaries Sue HHS Over 489-Day Backlog in ALJ Appeals

The Center for Medicare Advocacy (CMA) filed a complaint last week on behalf of five Medicare beneficiaries in federal district Court in Connecticut requesting a court order requiring the Secretary of HHS to clear a massive...more

OMHA Announces Two New Programs to Address Appeals Backlog

The Office of Medicare Hearings and Appeals (OMHA), which oversees the Administrative Law Judge (ALJ) level of appeal, recently posted two important announcements regarding a new Statistical Sampling Initiative (SSI) and...more

Medicare’s Recovery Audit Program (RAC Audits), An Update For Physicians

As many physicians now realize, Recovery Audit Contractors ("RAC") hired by Medicare have turned their attention from hospitals and are now actively pursuing claims submitted by physicians. An audit by a RAC can put a...more

Assessment Appeals Commission Holds that Personal Property is Valued at Capitalized Cost

The Assessment Appeals Commission (“AAC”) of the Tennessee State Board of Equalization has reversed a 2011 administrative law judge decision, holding that intangible costs (such as freight, installation, engineering costs and...more

No Judicial Review of Contractor’s Finding of a High Payment Error Rate, a Condition for Extrapolation

Before a Medicare contractor can use extrapolation to determine an overpayment amount, the Medicare statute requires that it must make a finding that there is a sustained or high level of payment error or that documented...more

MoFo New York Tax Insights - Volume 4, Issue 1 - January 2013

In This Issue: Court of Appeals Reverses Appellate Division, Holds that EchoStar’s Equipment Purchases Qualified as Sales for Resale; Appellate Court Holds Electronic Messaging Services Subject to Sales Tax; ALJ Finds...more

Stepping Into the Ring Against the SEC and FINRA: Sometimes It Pays to Duke It Out Against the Regulators

Originally published in Thomson Reuters - Securities Regulation Law Journal - Winter 2012. Faced with the possibility of litigating against the Securities and Exchange Commission (SEC) or the Financial Industry...more

ALJ Appeals Frequently Favorable To Providers; OIG Calls For Reforms

The OIG recently published a report reviewing the implementation of 2005 regulations regarding the administrative law judge (ALJ) level of appeals, the third level of the Medicare appeals system. The 2005 regulatory changes...more

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