In May 2014, the American Hospital Association (AHA) filed suit to compel the U.S. Department of Health and Human Services (HHS) to comply with the 90-day statutory deadline to decide Administrative Law Judge (ALJ) hearings. ALJ review is the third of four levels in the administrative appeal process set out in the Medicare Act. The court dismissed the case, but the AHA filed an appeal and the lower court’s decision was overruled by the U.S. Court of Appeals for the District of Columbia Circuit (DC Circuit). Now, in a Memorandum Opinion filed December 5, the DC Circuit stated, “The secretary’s [HHS Secretary Silvia Burwell] latest brief does not provide enough evidence of progress to tilt the scales,” in favor of Burwell’s stay request regarding the appeal, adding that “the agency is also bound by statutorily mandated deadlines, of which it is in flagrant violation as to hundreds of thousands of appeals.”
The Court adopted a remedy with deadlines and mandatory percentage reductions, as suggested by AHA, as follows:
- 30 percent reduction from the current backlog of cases pending at the ALJ level by December 31, 2017
- 60 percent reduction from the current backlog of cases pending at the ALJ level by December 31, 2018
- 90 percent reduction from the current backlog of cases pending at the ALJ level by December 31, 2019
- 100 percent reduction by December 31, 2020
AHA had also proposed the remedy that the DC Circuit automatically issue rulings for defendants as of January 1, 2021, for any cases whose appeals have been pending at the ALJ level without a hearing for more than one calendar year. The court denied that request, but stated plaintiffs had other recourse in that event.
