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OIG Cites Shortcomings in Medicare Appeal ALJ Hearings

On November 14, the Office of Inspector General (“OIG”) of the Department of Health and Human Services (“HHS”) issued a report stemming from a review of the Administrative Law Judge (“ALJ”) level of the Medicare appeals system. The study analyzed all ALJ appeals decided in fiscal year 2010 from a multitude of perspectives, including interviews of ALJ staff and Qualified Independent Contractors (“QICs”), charged with administering the second level of appeal.

The report compiled ten recommendations for changes to enhance the ALJ level of appeal. OMHA and CMS responded to each of these recommendations. The report and agency comments are available here. This table is a summary of the recommendations in the left hand column and a summary of the agencies’ response on the right.

Should you have any questions regarding Medicare Administrative Law Judge hearings or other questions regarding Medicare audits, please contact Abby Pendleton, Esq. or Jessica Gustafson, Esq., or visit The HLP website.

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