A U.S. District Court judge last week dismissed a lawsuit by hospitals seeking to compel HHS to meet statutory timelines for processing appeals to recovery audits.
The American Hospital Association said in a statement last Friday that it disagrees with the court's decision and expects to file an appeal.
“While the court itself recognizes that hospitals simply cannot afford to have billions of dollars that are needed for patient care tied up indefinitely in the appeals process, its decision means that hospitals will be compelled to endure a prolonged 'waiting game,' the AHA said. “We are extremely disappointed that a court entirely insulated from the devastating effects of multi-year delays in payments for medical care as a result of bureaucratic mismanagement would find in favor of the government.”
The AHA sued HHS Secretary Sylvia Mathews Burwell in May alleging that the appeals process, which allows hospitals and doctors to challenge claims by recovery auditors for allegedly incorrect payments made by the CMS, is excruciatingly sluggish—so slow that they say it's against the law. The program has had a backlog that stretches as long as two years. Hospitals say they may have to wait as long as five years to complete the process because of delays in adjudication.
The AHA argued in its initial complaint that the CMS is in violation of the Medicare Act, which requires hospitals to process appeals within about one year. They blame the delay on the government's use of recovery audit contractors, or RACs, private auditors that investigate Medicare claims and get a cut of any improper payments recovered. The AHA says RACs increase the workload of appeal adjudicators.
HHS claims that it doesn't have enough funding to properly address the situation. For that and many other reasons, the delays are not enough to warrant judicial action, according to a dismissal ruling issued last Thursday by Judge James Boasberg of the U.S. District Court for the District of Columbia.