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Medicare Appeals Backlog – Light at the End of the Tunnel?

The number of Medicare appeals cases pending to be heard by administrative law judges has been growing exponentially.  The backlog is now almost ten times larger than it was five years ago and is projected to reach two million by 2020 if no change is made.  The appeals process, as of now, takes at least three to four years, during which all funds are recouped.

In light of this continuing backlog, different organizations have taken to the courts to mitigate the challenges of the Medicare appeals process. Cases are currently pending where judges have expressed their frustration at the backlog and have ordered it be cleared in the next several years.Although HHS has claimed that it dedicated all available funds to the pending cases without relief, courts are growing impatient at the inequitable result of lengthy appeals processes.

However, courts are also struggling with balancing prompt appeals against merit-based settlements.  Although aggravated that HHS has blatantly ignored deadlines that have been established for appeals, courts need HHS to resolve cases on their merits and not for the sole purpose of clearing the backlog.  Further, courts understand the importance of trying to protect tax payer dollars by not allocating excessive amounts of money to speedy, merit-less settlements.

HHS has recently stated in court that since Congress boosted appropriations, it plans to hire at least eighty more administrative law judges which would allegedly allow the office to catch up on its backlog by 2022.  Both the courts and Congress are on notice of the problem of the growing backlog so the end may be in sight.

For guidance from expert legal counsel on your Medicare appeal, do not hesitate to contact our knowledgeable and experienced attorneys at 212-668-0200 or by email at 

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Friday, December 01, 2023