AHA's RAC appeals lawsuit dismissed

Hospitals appealing recovery audit contractor (RAC) clawbacks will get no legal relief, at least for now.

A judge in the District of Columbia has dismissed the lawsuit, concluding that the current backlog in RAC appeals cases did not warrant legal intervention, AHA News Now reported.

In his 21-page decision, Judge James E. Boasberg ruled the statutory delays did not really impact the delivery of healthcare services by the plaintiffs, which included the American Hospital Association (AHA), Baxter Regional Medical Center in Arkansas, Covenant Health in Tennessee and Rutland Regional Medical Center in Vermont, and therefore had to be weighed against the priority of keeping the U.S. Department of Health and Human Services.

As a result, Boasberg granted a motion by the HHS to dismiss the suit, which was filed last spring.

"While the Court sympathizes with plaintiffs' plight, for the time being the waiting game must go on," Boasberg wrote. "HHS' delay in processing their administrative appeals, while far from ideal, is not so egregious as to warrant intervention."

There is a five-step process for appealing a decision by a RAC to deny a hospital Medicare claim, including a hearing in from of an administrative law judge. However, the system has been so clogged with RAC appeals that it is now expected to take two years or more to see an appeal end from start to finish.

The AHA said it would likely appeal the decision.

"We disagree with the court's decision not to compel the Department of Health and Human Services to meet statutory deadlines for timely review of Medicare claims denials on the basis of 'competing priorities,'" said AHA Chief Executive Officer Richard Umbdenstock, who added that the organization "will call upon the government to identify those priorities that trump providing hospitals with the necessary resources to provide essential care to the nation's elderly and most vulnerable patients."

To learn more:
- read the AHA News Now article
- check out the court decision (.pdf)