Congress grills top judge on appeals jam backlog

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Rep. Tammy Duckworth (D-IL)
Rep. Tammy Duckworth (D-IL)

There is no easy fix to the staggering backlog of Medicare appeals, a government official said during a July 10 Congressional hearing.

 “Zealous” anti-fraud efforts have created an imbalanced system, Chief Administrative Law Judge Nancy J. Griswold told the healthcare subcommittee of the House Committee on Oversight & Government Reform. Recovery Audit Contractor activity has been linked to rising provider appeals. 

Griswold said that Health and Human Services Secretary Sylvia Mathews Burwell is committed to “restoring balance.”

There are not enough temporary ALJs to resolve the appeals backlog, Griswold said. Her agency recently announced an alternative dispute resolution process for providers to minimize ALJ involvement. She urged action to boost ALJ funding.

ALJ appeals often involve “crazy stuff,” such as signatures in the wrong place, said Rep. Mark Meadows (R-NC). More than 100 orthotics and prosthetics suppliers have gone out of business while waiting to be paid, said Rep. Tammy Duckworth (D-IL). 


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