Client Alert: Clearing the Logjam: District Court Issues Deadlines for HHS to Eliminate the Medicare Payment Appeals Backlog

Client Alerts Commercial Litigation Healthcare

Client Alert

In a decision highly anticipated by health care providers and others, the U.S. District Court for the District of Columbia has held that the Department of Health and Human Services has four years to eliminate the substantial backlog of Medicare payment appeals awaiting review (Am. Hosp. Ass’n v. Burwell, 12/5/2016). This Client Alert, authored by Trevor Presler and William Stewart of the Wyrick Robbins Healthcare Practice Group and PJ Puryear of the Commercial Litigation Practice Group, describes the administrative process by which Medicare providers can appeal the denial of a reimbursement claim, explains how the appeals backlog developed, summarizes the court decision and its procedural history, and suggests that one likely consequence of the decision is that reimbursement claimants seeking review of an adverse determination could gain leverage toward a more favorable result.