Wednesday, September 3, 2014

CMA Sues HHS Over Medicare Appeals

Dianne De La Mare

The Center for Medicare Advocacy (CMA) has filed a nationwide class action lawsuit (Lessler v. Burwell) in the US District Court in Connecticut alleging that the 5 named beneficiaries in the case have waited longer than the statutory 90-day limit for a decision on their Medicare appeals.

Under the Medicare Act, administrative law judges (ALJs) have only 90 days to issue a ruling on a disputed claim after a request for a hearing. However, the wait time now is five times the congressionally mandated time limit, according to CMA. This suit was filed just months after CMA filed a previous suit alleging that the unjust and time-consuming Medicare appeals process essentially “rubber stamps” denials at the first two levels of the appeal.

The most recent CMA suit acknowledges that the ALJ hearing is the third level of the appeal, and represents the first chance for a meaningful review of a beneficiary’s appeal; but it is hopelessly and illegally delayed.

AHCA/NCAL agree that HHS must ensure that the Medicare appeals process furnishes legitimate reviews through all levels of the Medicare appeals process and that both beneficiaries and providers complaints are heard in a timely and just manner.

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