The Broken Medicare Appeals System: Failed Regulatory Solutions and the Promise of Federal Litigation

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Vol: 28, Issue: 1, Page: 269

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Donley, Greer
Medicare appeals system; Medicare litigation; Medicare payments; due process; Health Law and Policy
article description
The Medicare Appeals System is broken. For years, the System has been unable to accommodate a growing number of appeals. The result is a backlog so large that even if no new appeals were filed, it would take the System a decade or more to empty. Healthcare providers wait many years for their appeals to be heard before an Administrative Law Judge (ALJ), and because the government recoups providers' Medicare payments while they wait, the delays cause them serious financial harm. Even worse, providers are more likely than not to prevail before the ALJ, proving that the payment should never have been recouped in the first place. The financial pressure on providers creates widespread reverberations in the healthcare market, and consumers ultimately pay the price. Nevertheless, the government appears unwilling or unable to fix the problem. This Article explores how the System works, why the System broke, and what legal or legislative remedy could solve its problems.