AHA wants speedy end to RAC backlog lawsuit

The American Hospital Association (AHA) and other hospitals and health systems suing the federal government over adjudicating disputed Medicare claims in a timely manner have become more assertive in their lawsuit.

The AHA and the other plaintiffs filed a motion for summary judgment--essentially a request for an immediate victory in their lawsuit--saying that under federal law it is the only way to obtain relief in the matter.

The AHA, Baxter Regional Medical Center in Arkansas, Rutland Regional Medical Center in Vermont, and nine-hospital Tennessee-based Covenant Health sued the U.S. Department of Health and Human Services back in May, claiming that the five-step system for appealing a claims denial was taking too long to navigate and resulting in delays that could be counted in the years.

The system, which includes internal appeals and hearings in front of federal administrative law judges, was set up to contest denials of Medicare claims by recovery audit contractors or RACs. RAC audits began in 2009, launching an ongoing battle between the contractors, hospitals and other providers over billions of dollars in claims.

Currently, there are about 480,000 appealed RAC denials that are awaiting hearings in front of administrative law judges. HHS imposed a temporary moratorium on resolving appeals in administrative law courts late last year, leading to the lawsuit. The AHA claims that the backlog would now take as long as three years to resolve, tying up billions of dollars in revenue in the meantime.

The average time to obtain an administrative law hearing is now 387days, and the courts receive the equivalent of a year's worth of appeals every four to six weeks, Nancy Griswold of the Office of Medicare Hearing and Appeals told a House subcommittee.

The AHA and the hospitals claim that the U.S. Department of Health and Human Services has a statutory obligation to resolve the appeals within 90 days, therefore entitling it and the other plaintiffs to immediate relief.

To learn more:
- read the motion for summary judgment (.pdf)
- watch Griswold's testimony

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