AOPA Submits Comments on OMHA’s ALJ Backlog and Increased Requests for Hearings


Following the October 29 Medicare Appellant Forum hosted by the Office of Medicare Hearings and Appeals (OMHA), the Department of Health and Human Services (HHS) opened a comment period to solicit suggestions for addressing the growth in the number of requests for Administrative Law Judge (ALJ) hearings, and to help to clear the backlog of pending cases.

As you may be aware, the OMHA office is receiving approximately 14,000 appeals per week, compared to the 1,250 per week in 2011 prior to the “Dear Physician” letter and subsequent increase in auditing activities. While OMHA has received a modest budget increase to expand operations, and are implementing several pilot programs, the O&P Community has yet to feel any relief. The current wait time for an ALJ Hearing is 414 days from the time of the request until the decision.

In our comments, AOPA emphasized the following points:
1.  Recovery Audit Contractor (RAC) Activities Must be Re-Focused
2.  CMS Should Offer Orthotic and Prosthetic Providers the Opportunity to Voluntarily Settle Claims that are Awaiting an ALJ Hearing Using a Statistically Valid Extrapolation Process
3.  OMHA Should Overturn Claim Denials that Cannot be Scheduled for an ALJ Hearing Within 90 Days of a Hearing Request
4.  Coordinated Actions Needed by HHS, CMS and OMHA
5.  OMHA Must be Funded at a Level that Supports its Increased Workload

You can read the full comments submitted here.