The U.S. District Court for the District of Columbia issued an order on December 5, 2016 compelling HHS to meet certain annual targets to resolve its backlog of hundreds of thousands of pending Medicare claim appeals. HHS recently asked the district court to reconsider its order, arguing that HHS does not have the sufficient resources to meet these targets.
The American Hospital Association and affiliated entities initiated the litigation, requesting a writ of mandamus to compel the Secretary of HHS to adjudicate pending Medicare appeals in compliance with statutorily imposed deadlines. The district court’s December 5 order established the following targets for HHS to resolve the backlog: 30 percent through 2017, 60 percent through 2018, 90 percent through 2019, and 100 percent through 2020.
HHS filed a motion for reconsideration of the district court’s order on December 15. In its motion, HHS argues that it cannot meet the scheduled reduction targets without “substantial new resources and authorities” that Congress has not provided. Without these resources, HHS says that the only way to meet the targets would be to pay pending claims without regard to their merit, which is prohibited by the Medicare statute. HHS argues that this leaves it trapped between “a statutory rock and a statutory hard place.” Accordingly, HHS asked the district court to set aside the mandatory targets and leave resolution of the backlog to HHS’s discretion.
HHS previously made these same arguments to the district court to no avail. In its December 5 opinion the district court heeded plaintiffs’ argument that it must assume Congress is “unlikely to play the role of the cavalry” to provide additional resources through legislation. The district court also rejected HHS’s argument that it would be required to pay non-meritorious claims, explaining that the deadlines simply require HHS to figure out how to undertake proper claim substantiation within a reasonable timeframe.
HHS noted in prior filings that it has eliminated hundreds of thousands of hospital appeals through settlement—which does not violate the prohibition against paying non-meritorious claims—and plans to compromise or settle thousands more. HHS does not explain in its new motion why it cannot address the backlog through settlement or compromise.
The case is Am. Hosp. Ass'n v. Burwell, No. 14-cv-851 (D.D.C.). Please click here for a copy of the HHS motion. For a copy of the district court’s December 5 opinion, please click here.
