ALJ Delay Stops Due Process for Providers

In a recent Office of Medicare Hearings and Appeals (OMHA) forum on the overwhelming administrative law judge (ALJ) appeal backlog, AAHomecare’s Tom Ryan and Jay Witter listened to Chief Judge Nancy Griswold and others from CMS discuss the situation and their proposed solutions. However, as Ryan pointed out during the forum’s Q&A portion, “The entire audit process is broken.” Prior to the forum, AAHomecare sent a letter to Department of Health and Human Services Secretary Kathleen Sebelius listing options that would address audit reform from the ground up. “The response by the ALJ to simply not schedule any more hearings until they catch up is breaking the law,” said Ryan. “By doing so, they have effectively stopped due process for providers and suppliers in all segments of health care until further notice.” AAHomecare also sent a copy of the letter to the Government Accountability Office (GAO) to help with their investigation into pre- and post-payment audits. AAHomecare is following-up with OMHA, GAO, and Secretary Sebelius to continue pushing for long overdue changes in the audit and appeal process. There is a good deal of information in the forum’s presentation materials. Click here to view the PowerPoint slideshow.