08/28/2014    

IN THE COURTS

Center for Medicare Advocacy Sues to Fix Broken Medicare Appeals System

 

The Center for Medicare Advocacy filed a nationwide class action lawsuit in United States District Court in Connecticut today (Lessler, et al. v. Burwell, 3:14-CV-1230, D. Conn.). The five named plaintiffs from Connecticut, New York, and Ohio have all waited longer than the statutory 90-day limit for a decision on their Medicare appeals. The current average wait time is over five times the congressionally mandated time limit.

 

The Medicare Act requires Administrative Law Judges (ALJs) to issue decisions within 90 days after a request for a hearing. Yet, as of July 2014, the current wait time for a decision averaged 489 days. Due to an unjust and time-consuming Medicare appeals process that essentially “rubber stamps” denials at the first two levels of appeal, the ALJ hearing is the third level of appeal, and represents the first chance for a meaningful review of a beneficiary’s appeal – which can include the chance to provide oral and witness testimony.