Kusserow on Compliance: Federal court extends the clearing of Medicare backlog out to 2022

Last year, the U.S. District Court for the District of Columbia ordered HHS to eliminate pending Medicare claims appeals and outlined a schedule for reducing the backlog that was to be completed by 2020. The court has been frustrated with HHS’ inability to process appeals. HHS has made repeated court appearances where it pleaded for additional time to eliminate the backlog, citing the impossibility of complying with the court’s order. After considering all the appeals by HHS, the court extended its mandate to 2022 after noting that Congress appropriated $182.3 million for addressing the appeals backlog earlier this year. HHS reported that this additional funding “has made compliance possible within four years” and agreed that the new deadline makes it possible for HHS to comply with the order requiring that the backlog be reduced and then eliminated on the precise timeline that HHS projected. This eliminates any future claim by HHS of not being able to meet the deadline that was established by its own projections. The court refused to order a reduction of interest charged on funds that HHS has yet to recoup from providers while appeals are pending or to allow providers to “rebill” claims for six months following the decision.


Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2018 Strategic Management Services, LLC. Published with permission.