News & Analysis as of

Appeals ALJ

Update: HHS Announces Two Additional Medicare Appeals Settlement Initiatives

by Polsinelli on

On Nov. 3, Health & Human Services (HHS) announced two additional initiatives to address the mounting Medicare appeals backlog at the Administrative Law Judge (ALJ) level: (i) expand the Settlement Conference Facilitation...more

October 2017: The Top 11 Labor And Employment Law Stories

by Fisher Phillips on

It’s hard to keep up with all the recent changes to labor and employment law. While the law always seems to evolve at a rapid pace, there have been an unprecedented number of changes each month in 2017. October was no...more

ITC Re-Opens Investigation in Response to Federal Circuit Reversal

by Jones Day on

In response to the Federal Circuit’s reversal of the ITC’s indefiniteness and invalidity finding, the Commission remanded the investigation to ALJ with instructions to issue an ID within 30 days....more

Employer’s Victory In Workers’ Compensation Proceeding Leads To Dismissal Of Discrimination Claims

A recent California Court of Appeal opinion reminds employers of the need to carefully monitor parallel workers’ compensation proceedings involving litigants who also have civil claims pending against the employer. Ly v....more

Tenth Circuit Vacates ARB Whistleblower Decision

On October 17, 2017, the Tenth Circuit overturned the ARB’s decision in favor of complainant for want of protected activity under SOX. Dietz v. Cypress Semiconductor Corp., No. 16-9529 (Oct. 17, 2017). This decision rolled...more

Employment Law - October 2017

Employer Bound by Oral Contract, California Appellate Court Affirms - Why it matters - Upholding an oral contract, the California Court of Appeal agreed with an employee that she should be paid a commission for certain...more

Lorenzo's a Schemer, Not a Maker; Dissent Blasts SEC ("Not Fair," "Stinks")

by Burr & Forman on

Cut, paste and forward ? just as the boss instructed. But Lorenzo’s email to two clients was misleading, so the SEC filed an enforcement action. The ALJ held Lorenzo liable for violating anti-fraud provisions and imposed a...more

CMS Announces CY 2018 Amount in Controversy Thresholds for Medicare Appeals

by Reed Smith on

CMS has released the calendar year (CY) 2018 amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The CY 2018 AIC threshold amounts...more

Federal Circuit Stay Order Demonstrates Value of Redesign as Defense in ITC Actions

by Jones Day on

The Federal Circuit has determined to partially stay an ITC exclusion order as it pertains to products redesigned after the remedial orders issued. We have previously posted about Certain Network Devices, Related Software and...more

Medicare Appeals Backlog: A Setback and New Opportunities for Providers

by McDermott Will & Emery on

As of June 2017, the Office of Medicare, Hearing and Appeals (OMHA) had 607,402 appeals pending with a current estimated wait time of three years for an Administrative Law Judge to process a provider’s appeal. At this rate,...more

Court of Appeals Reverses D.D.C. Order Requiring HHS to Eliminate Medicare Appeals Backlog by December 31, 2020

by Baker Ober Health Law on

Hopes were dashed for sooner relief from the backlog of Administrative Law Judge (ALJ) appeals. With the backlog of Medicare reimbursement appeals steadily growing, a reversal by the U.S. Court of Appeals for the District of...more

How Utah evaluates a worker’s entitlement to PTD benefits

by Kirton McConkie PC on

Have you ever thought about how the word “limit” de­fines our perceptions of and interactions with the world around us? The concept of a “limit” engenders thoughts of a bound­ary, an edge, or an end. When we say something is...more

Expanded PTO Panels and Improper Joinder: The Federal Circuit Fires a Warning Shot

by Jones Day on

The Federal Circuit’s decision in Nidec Motor Corp. v. Zhongshan Broad Ocean Motor Co., (Fed. Cir. No. 16-2321), expresses a growing discomfort with the Patent Office’s practice of joinder and expanded panels....more

Recent Eighth Circuit Case Illustrates the Need for Newest Members of the NLRB to Be Confirmed Sooner Rather Than Later

In another example of a federal circuit court taking the National Labor Relations Board (NLRB) to task for stretching federal labor law past the point of recognition, the Eight Circuit Court of Appeals recently refused to...more

NLRB’s Acted More Like “Advocate Than Adjudicator” In Issuing Decision, DC Court of Appeals Concludes

When bargaining over an agreement, it is common to hear union representatives ask “why do we need such elaborate language in an agreement? We are always reasonable.” To which, the company usually responds, “We think you’re...more

Standard for Claim Indefiniteness Virtually Relaxes

by McDermott Will & Emery on

Addressing claim indefiniteness, the US Court of Appeals for the Federal Circuit concluded that the claim term “virtually free from interference” was sufficiently definite to pass § 112 muster. One-E-Way, Inc. v. Sony Corp.,...more

LabMD – FTC Face-Off Continues Over FTC’s Data Privacy Authority

by Patrick Law Group, LLC on

The U.S. Court of Appeals for the Eleventh Circuit recently heard oral arguments in LabMD, Inc. v. Federal Trade Commission, the long-running dispute over the FTC’s authority to impose liability for data security breaches...more

Environmental Case Law Update – 1st Six Months of 2017

On March 21, 2017, the United States Supreme Court decided the case of National Labor Relations Board v. SW General, Inc. This case concerns the operation and application of the Federal Vacancies Reform Act of 1998 (FVRA). ...more

Safety Agency Applies Federal Law To Bar Employer Safety Violation Citation - Agency’s Application of 5th Circuit Appeals Court...

by Fisher Phillips on

The federal agency that reviews OSHA safety violation cases, also known as the OSH Review Commission, recently adopted the decision of one of its Administrative Law Judges who applied 5th Circuit precedent to reject a safety...more

HHS Final Rule on Medicare Coverage Determination Appeals Process Takes Effect

by King & Spalding on

HHS’s final rule revising procedures for ALJ and Medicare Appeals Council level appeals, announced on January 17, 2017, took effect on March 20, 2017....more

Supreme Court Increases School Standards For Students With Disabilities

by Fisher Phillips on

IEPs Must Meet “Markedly More Demanding” Standard From Now On This week, in a unanimous decision crafted by Chief Justice John Roberts, the Supreme Court decided that the Individuals with Disabilities Education Act...more

Advertising Law - March 2017

FTC Fights Back in LabMD Suit - The Federal Trade Commission demonstrated its intention to fight for the power to regulate data security by filing a 111-page brief with the U.S. Court of Appeals for the Eleventh Circuit...more

The National Labor Relations Board 2016 Year in Review – Whitepaper

Introduction - In comparison to recent history, 2016 was a tame year for the National Labor Relations Board (“NLRB” or “the Board”). While continuing to issue decisions that left employers scratching their heads, the...more

HHS Publishes Final Rule Overhauling the Medicare Appeals Process

by Baker Ober Health Law 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

Medicare Appeal Proposal Falls Far Short of Court Mandate

by Faegre Baker Daniels on

For years the hospital industry has been in an uproar over the mountainous backlog of Medicare claim appeals. Current estimates are that a whopping 650,000 claims are at the Administrative Law Judge level awaiting...more

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