Court vacates order requiring HHS to clear Medicare appeals backlog

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The Department of Health and Human Services will have another shot at explaining why it believes a four-year timeline is “impossible” for clearing out the current backlog of Medicare claims appeals, thanks to a recent court ruling.

HHS was ordered by a court last year to eliminate the backlog by the end of 2020, which the department decried as a “clear error” that couldn't be achieved without additional resources. Federal health officials have since issued a rule aimed at cleaning up the claim appeals process.

In an opinion reached last week the U.S. Court of Appeals for the District of Columbia Circuit ruled that the lower court's imposition of the four-year timeline suggested by the American Hospital Association, which sued HHS over the backlog, didn't give enough weight to HHS' arguments that the deadline would be impossible to abide by.

“[The] Court declined to seriously grapple with the Secretary's assertion that lawful compliance with such a mandamus order would be impossible,” wrote Judge Robert L. Wilkins in the court's 2-1 opinion. “That is, the Court commanded the Secretary to perform an act — clear the backlog by certain deadlines — without evaluating whether performance was possible. The Court declared that a party ought without regard for whether the party can.”

The court vacated the order to have the backlog cleared by 2020, and remanded the case back to district court to determine whether HHS' claim that compliance with the timeline would truly be impossible. The district court could reissue the order “without modification” if HHS cannot demonstrate the “impossibility” of the timeline, Wilkins noted.

AHA leaders told Bloomberg BNA that they “don't believe the government will be able to meet the high standard of impossibility set out by the appeals court.”