Tag: Administrative Law Judge (ALJ)
Viemed prevails in ALJ appeal, Medicare returns money
January 23, 2023HME News Staff
AFAYETTE, La. – An Administrative Law Judge has ruled in favor of Viemed Healthcare, overturning all remaining disputed claims for equipment services, related to findings from the Office of Inspector General.
As a result, Medicare Administrative Contractors returned 100% of the previously remitted funds to Viemed.
“We are extremely pleased with the judge’s decision in this matter, which reaffirms the high integrity of our clinical protocols and sets the record...
To be continued ...
March 17, 2022Liz Beaulieu, Editor
When we included a Q&A with Josh Britten in our HME Newswire in February, I wasn’t surprised it resonated with readers.
Britten, CEO of BritKare Home Medical, shared his battle to get back nearly $650,000 in denied Medicare claims – a battle that took him six years and more than $100,000 in legal and consultant fees.
One provider responded to the story on Twitter by writing: “When you incentivize claims denial as a means of revenue generation you will find reasons to deny...
Provider vindicated but wary
February 25, 2022Liz Beaulieu, Editor
AMARILLO, Texas – Provider Josh Britten appealed $650,000 worth of denied Medicare claims back in 2015 and it took him six years and more than $100,000 to get it back. And he’s one of the lucky ones – he had the resources to stick with it.
“We filed our third appeal in 2015 and we finally received a decision in 2021,” said Britten, CEO of BritKare Home Medical. “We were six years waiting on a decision (at the ALJ level) that should have taken 90 days.”
Here’s...
ALJ backlog: Providers will have ‘fighting chance’ again
February 18, 2022Liz Beaulieu, Editor
ATLANTA – The Office of Medicare Hearings and Appeals should be caught up on a years-long backlog of appeals at the administrative law judge (ALJ) level sometime this summer, predicts Wayne van Halem, president of the van Halem Group.
That means OMHA should be back to holding hearings at the ALJ level within 90 days as required by law, he says.
“The appeals process has to be timely,” he said. “If the appeals process is timely and Medicare has to hold off...
DME appeals represent 42% of ALJ backlog, AAH says
March 12, 2021HME News Staff
WASHINGTON – The Office of Medicare Hearing and Appeals (OMHA) has shared with AAHomecare that there were 201,292 appeals in the ALJ backlog at the end of 2020, about 85,000 of which involved DME. That’s a significant drop from 2019, the association says, when there were 318,000 appeals in the ALJ backlog, about 173,000 of which involved DME. In past years, DME appeals have represented up to 55% of the ALJ backlog, AAHomecare says.
OMHA reduces ALJ backlog
November 19, 2020HME News Staff
WASHINGTON - The Office of Medicare Hearings and Appeals is back to operating at full capacity and is making its way through a backlog of appeals at the Administrative Law Judge level, AAHomecare reports. As of Oct. 31, 2020, there are about 85,000 DMEPOS appeals pending at the ALJ, a decrease of 51% compared to nearly 173,000 in 2019. OMHA also reported that the average wait time for an ALJ hearing is still four years, but it believes that should decrease as judges work their way through the backlog....
Q&A: Atty Matthew Fischer on appeals
October 28, 2019Liz Beaulieu, Editor
MIAMI - Matthew Fischer, a former senior attorney adviser for the Office Medicare Hearings and Appeals, has seen the ugliness of the appeals backlog from the inside. Here's what Fischer, now an attorney with the Zumpano Patricios, had to say about how to work a flawed system.
HME News: What did the appeals system look like from the inside?
Matthew Fischer: When I got there in 2011, I'd be looking at cases from two or three years ago. I thought, what is going on? They just didn't...
HHS reports 25% reduction in appeals backlog
October 16, 2019HME News Staff
WASHINGTON - The Department of Health and Human Services has reduced the backlog of Medicare appeals at the administrative law judge level by 25% through June 30, according to a status report provided to a federal court and obtained by the American Hospital Association.
The status report is part of a federal court ruling last year that established annual deadline-based targets for reducing the backlog of Medicare appeals at the ALJ level.
From Nov. 1, 2018, through the end of the third quarter...
New court decision on recoupments
February 15, 2019Liz Beaulieu, Editor
WASHINGTON - Healthcare attorney Elizabeth Hogue has been watching closely as numerous courts go back and forth on whether or not CMS should be stopped from recouping overpayments until after the ALJ level, but she thinks a recent court's decision is “really serious.”
Here's what Hogue had to say about a Florida district court's decision to deny a home health agency's request for a preliminary injunction to stop recoupments before an ALJ hearing on the grounds that...
CMS expands phone demo
October 23, 2018HME News Staff
JACKSONVILLE, Fla. - CMS will expand a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases to jurisdictions A and B on Nov. 1.
The agency cited “strong support from the supplier community and the initial success of the demonstration” as reasons to expand the phone demo.
“Effective on or after Nov. 1, the DME QIC will offer telephone discussions and/or re-openings to DME suppliers within the DME...