OMHA

News & Analysis as of

A (Second) Lawsuit Seeks to Compel Statutory Timeframe for Administrative Law Judge Review of Medicare Claims Appeals

On August 26th, the Center for Medicare Advocacy filed a nationwide class action lawsuit against the Secretary of Health and Human Services. The complaint alleges that, as implemented, the Medicare administrative review...more

Hospitals File Lawsuit Over Medicare ALJ Hearings Delays

Over 460,000 appeals requesting hearings before an administrative law judge (ALJ) were pending in the Office of Medicare Hearings and Appeals (OMHA) at the end of 2013, with 15,000 new appeals being submitted each week. At...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

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

RAC Program to Resume Limited Reviews

On August 4, 2014, the Centers for Medicare and Medicaid Services (CMS) announced that it would allow the Recovery Audit Contractor Program (RAC) to resume a limited number of reviews in August. The program has been dormant...more

OMHA Announces Two New Programs to Process Administrative Law Judge (ALJ) Hearings More Efficiently

Earlier this year, the Office of Medicare Hearings and Appeals (OMHA) announced that for most hearing requests received after April 1, 2013, it will be deferring assignment of ALJs. OMHA’s announcement is available on its...more

Hospitals File Lawsuit Over Medicare ALJ Hearings Delays

Over 460,000 appeals requesting hearings before an administrative law judge (ALJ) were pending in the Office of Medicare Hearings and Appeals (OMHA) at the end of 2013, with 15,000 new appeals being submitted each week. At...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

For New Recovery Audit Contracting Cycle, CMS “RAC”s up Changes

Last month, the Centers for Medicare & Medicaid Services (CMS) announced important changes to the Recovery Audit Program. The agency had already begun the procurement process to find new Recovery Audit Contractors (RACs) in...more

Highlights from OMHA's Medicare Appellant Forum

The Office of Medicare Hearings and Appeals (OMHA) recently announced that for most hearing requests received after April 1, 2013, it will be deferring assigning to Administrative Law Judges (ALJs). OMHA will continue to...more

OMHA Holds Medicare Appellant Forum

On February 12, 2014, the Office of Medicare Hearings and Appeals (OMHA) held a “Medicare Appellant Forum” in Washington, DC. The event was well-attended, with 300 people signed up to be present in-person, and 500 who signed...more

Government Imposes Moratorium on Medicare Hearings and Appeals

The Federal Office of Medicare Hearings and Appeals (OMHA) was established in July 2005 to administer the Medicare appeals program. OMHA adjudicates appeals regarding Medicare entitlement and Medicare provider reimbursement....more

OMHA Imposes 24-Month Stay for New ALJ Assignments; Announces Medicare Appellant Forum

The Office of Medicare Hearings and Appeals (OMHA) has issued a Memorandum to OMHA Medicare appellants announcing a temporary stay, effective for cases filed on or after July 15, 2013, in the assignment of new requests for...more

ALJ Hearing Assignment Suspension

As some of you may be aware, the Office of Medicare Hearings and Appeals (OMHA) has recently announced that it temporarily suspended the assignment of most new requests for Administrative Law Judge (“ALJ”) hearings, as of...more

OIG Concludes Improvements Needed at ALJ Level of Review

The OIG issued a report on November 15, 2012 (OEI-02-10-00340) in which it concluded that the administrative law judge (ALJ) level of appeal requires improvements in a number of areas due to (i) apparent substantive...more

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