News & Analysis as of

Medicare Appeals Council Appeals

King & Spalding

Fifth Circuit Holds District Court Has Jurisdiction to Decide Repayment Amount Owed by HHS to Medicare Provider as an...

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On January 3, 2022, the U.S. Court of Appeals for the Fifth Circuit Court reversed the decision of the District Court for the Western District of Louisiana dismissing for lack of jurisdiction a Medicare provider’s suit...more

Baker Donelson

Recent Litigation Underscores Continued Difficulties with the 'Logjam' of the 'Colossal' Medicare Claim Appeals Backlog

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Although newly released data from the Office of Medicare Hearings and Appeals (OMHA) suggests that the Medicare claim appeals backlog might be decreasing, OMHA's case processing time and recent litigation challenging the...more

K&L Gates LLP

OMHA to Host Call on Expanded Settlement Conference Facilitation on May 22, 2018

K&L Gates LLP on

The Office of Medicare Hearings and Appeals (“OMHA”) recently expanded the Settlement Conference Facilitation (“SCF”) program, an alternative dispute resolution process, to allow more providers and suppliers with pending Part...more

King & Spalding

CMS Announces Plans to Expand Settlement Options to Decrease Medicare Appeals Backlog

King & Spalding on

On November 3, 2017, CMS announced that it plans to implement two appeals settlement initiatives designed to decrease the backlog of Medicare appeals pending at the Medicare Appeals Council (MAC) of the Department Appeals...more

Baker Donelson

HHS Publishes Final Rule Overhauling the Medicare Appeals Process

Baker Donelson on

The Department of Health and Human Services (HHS) published its final rule revamping the Medicare appeals process at the Administrative Law Judge (ALJ) level on January 17, 2017. The final rule extensively revises federal...more

Latham & Watkins LLP

A Favorable, New Climate for Challenging Medicare Appeals

Latham & Watkins LLP on

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

King & Spalding

HHS Proposes Significant Changes to ALJ Hearing Procedures

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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

Baker Donelson

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

Baker Donelson on

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

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