As previously reported, the Center for Medicare Advocacy filed Exley v. Burwell on behalf of Plaintiffs appealing Medicare denials before an Administrative Law Judge and not receiving decisions within the 90 days required by law. The Fairness Hearing has been rescheduled for August 1, 2016.
This settlement addresses delays that Medicare beneficiaries have been experiencing at the Administrative Law Judge (ALJ) level of review. The class includes any Medicare beneficiary who has requested an ALJ hearing but did not have a decision issued within 90 days of the date the request for a hearing was filed. Among other things, the settlement calls for the Office of Medicare Hearings and Appeals (OMHA) to continue its policy of providing all beneficiary appellants with priority over other appellants in receiving ALJ decisions, to designate a Headquarters Division Director to oversee inquiries about appeals initiated by beneficiary appellants and to address any complaints or questions concerning the processing of those appeals. OMHA will also establish a toll-free help line for beneficiary appellants to be answered by the Division Director’s staff. OMHA will also introduce a new, more user-friendly ALJ hearing request form that allows beneficiaries to self-identify, and will also publish data about the length of processing time for beneficiary appeals.
The parties have agreed to a settlement in which the Office of Medicare Hearings and Appeals (OMHA) agrees to a number of changes in its appeal processes in exchange for class members dismissing their claims.