HHS says it can't clear Medicare appeals backlog by court's deadlines without more money

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The Department of Health and Human Services will be unable to meet court-ordered deadlines for clearing the Medicare appeals backlogs without additional funding, the agency told a court last week.

In a motion to the U.S. District Court for the District of Columbia filed on Thursday, HHS described the court's early December ruling that would require the agency to eliminate the backlog of pending reimbursement appeals by the end of 2020 a “clear error.”

The motion argues that the deadlines set in place by the ruling would require HHS to “pay pending claims without regard to their merit,” thus violating Secretary Sylvia M. Burwell's obligation to preserve the Medicare Trust Funds. The schedule could feasibly be met with the help of “substantial new resources and authorities,” which HHS notes were not provided by Congress.

To move ahead of the schedule as planned would cause “ significant damage to the Medicare Trust Funds,” HHS said.

“Thus, the [Dec.] 5 order traps the Secretary between a statutory rock and a statutory hard place,” the motion reads. “Because the Secretary is caught between two statutory mandates that are incompatible ... the Court should have left resolution of the conflict to the Secretary's discretion and allowed the Secretary to continue to address the backlog through the administrative measures she deems appropriate.”

HHS had made similar arguments about the schedule prior to the court's Dec. 5 decision. In that ruling, Judge James E. Boasberg responded that the timetable would not require HHS to pay claims regardless of merit. Rather, “it simply demands that the Secretary figure out how to undertake ‘proper claim substantiation' within a reasonable timeframe.”

Thursday's motion asks that the court respond by Jan. 31, 2017, ahead of the first deadline, which calls for HHS to reduce the backlog by 30% no later than Dec. 31 of that year.