2012 Amount in Controversy for Medicare Appeals Issued

Medicare Part A and Part B providers and suppliers appealing Medicare audit decisions at the administrative law judge (“ALJ”) level or through a judicial review must meet an amount in controversy (“AIC”) threshold amount pursuant to regulation at 42 CFR 405.1006(b) and (c). The regulations require the Secretary of the Department of Health and Human Services (“Secretary”) to publish annually the AIC threshold amounts in the Federal Register; the Centers for Medicare and Medicaid Services (“CMS”) published these new amounts in the September 23, 2011 Federal Register.

Requests for ALJ hearings and judicial review filed on or after January 1, 2012 require an AIC of $130 for ALJ hearings and $1, 350 for judicial review. CMS also provided the following table of AIC threshold amounts from 2005-12:

AIC Table.jpg

For more information on audit appeals, please contact Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. at (248) 996-8510 or (212) 734-0128 or visit the HLP website.

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