HHS: Medicare Appeals Backlog Order Impossible

It will be impossible to follow a federal court order to clear a huge Medicare appeals backlog by 2021, the Department of Health and Human Services (HHS) says.

The HHS filed a motion with the U.S. District Court for the District of Columbia asking the court to reconsider its Dec. 5 ruling because the department will not be able to hit the targets set by the judge unless they are given more money from Congress, according to court documents.

The backlog reduction targets are to be completed over the next four years. The first 30% of backlog cases would have to be completed by December 31, 2017.


The backlog formed in recent years due to several factors, including the aging of the population and more aggressive Medicare integrity efforts. Home health claims are among the 658,000 claims in the appeals backlog.

HHS did make the argument that it would not be able to complete the project without obtaining additional funds before the court issued the ruling, but the agency’s concerns were rejected.

Following the reduction timetable also would force HHS to violate Medicare law by paying non-meritorious claims, the motion said.


Rushing to reduce the backlog force HHS to violate its duty to protect the Medicare program, an agency official wrote in a declaration attached to the motion.

“The only way for the department to potentially meet such reduction targets without legislative action would be to settle claims of the full value or nearly the full value of each appeal without regard to its merit,” Ellen Murray, assistant secretary for financial resources and chief financial officer of the HHS, wrote in the declaration. “This measure would result in the payment of non-meritorious and sometimes fraudulent claims, and even still, might not resolve OMHA’s backlog, as it would also encourage appellants to flood the appeals system with every denied claim—regardless of merit— with the hope that it would eventually also be paid, which would make the backlog at OMHA even worse.”

Written by Alana Stramowski

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