United States District Court, District of Columbia
E. BOASBERG United States District Judge.
a half years ago, the American Hospital Association and
affiliated entities asked this Court to issue a writ of
mandamus to compel the Secretary of Health and Human Services
to adjudicate pending Medicare-reimbursement appeals in
compliance with statutorily imposed deadlines. Plaintiffs
sought relief from a morass in which hundreds of thousands of
appeals were languishing in a highly backlogged
administrative process. Now, after a motion for summary
judgment, a motion to dismiss for lack of jurisdiction, an
appeal to and remand from the D.C. Circuit, and a motion to
stay, the Court can finally grant Plaintiffs a remedy. The
incantation of mandamus does not generate an instantaneous
cure-all for complex problems, however, and so this Opinion
focuses on the form the relief will take.
frustrated by long delays in the administrative-appeal
process for Medicare-reimbursement claims, Plaintiffs filed
this suit in May 2014. See ECF No. 1 (Complaint).
Although sympathetic, the Court was reluctant to intervene
and thus initially concluded that mandamus was not warranted
and dismissed the case for lack of jurisdiction. Am.
Hosp. Ass'n v. Burwell (AHA I), 76
F.Supp.3d 43, 56 (D.D.C. 2014). The D.C. Circuit reversed and
remanded with instructions for further proceedings, including
a direction to this Court to “determine whether
‘compelling equitable grounds' now exist to issue a
writ of mandamus.” Am. Hosp. Ass'n v.
Burwell (AHA II), 812 F.3d 183, 192 (D.C. Cir.
remand, the Secretary moved to stay the proceedings until
September 30, 2017, the close of the next full appropriations
cycle, to permit HHS to pursue various administrative and
legislative efforts designed to tackle the significant
appeals backlog. See ECF No. 30 (Motion to Stay).
The Court denied that request. Am. Hosp. Ass'n v.
Burwell (AHA III), 2016 WL 5106997 (D.D.C.
Sept. 19, 2016). In so doing, it concluded that there existed
“equitable grounds for mandamus.” Id. at
*8. Recognizing, though, that it could not practicably order
HHS to resolve each of the pending appeals by the statutorily
prescribed deadlines, the Court asked the parties to address
in briefing the specific forms mandamus relief should take.
See Minute Order of Oct. 3, 2016. They have now done
so, although HHS has also asked the Court to reconsider its
prior decision to grant mandamus.
curious reader, a more detailed account of the
administrative-appeal process for Medicare-claim
reimbursements and the causes and scope of the backlog can be
found in the Court's prior Opinions. See AHA
III, 2016 WL 5106997, at *1-2; AHA I, 76
F.Supp.3d at 46-48.
requested by the Court, Plaintiffs devote serious thought to
possible actions the Secretary could undertake to address the
backlog of administrative appeals. They propose three
categories of discrete interventions and, in the alternative,
an overall timetable by which the Secretary must achieve
reductions in the backlog. See ECF No. 39 (Motion)
the reforms, Plaintiffs suggest that the Secretary should:
(1) offer reasonable settlements to certain broad groups of
Medicare providers and suppliers; (2) for some subset of
disputed Medicare claims, alleviate the financial strain on
providers by deferring their duty to repay the Secretary and
tolling the accrual of interest on those claims for waiting
times beyond the statutory deadlines; and (3) impose
financial penalties on Recovery Audit Contractors for high
reversal rates by Administrative Law Judges. See
Mot. at 4-11.
anticipating that the Court might prefer to avoid directing
the particulars of the Secretary's backlog-reduction
efforts, however, Plaintiffs alternatively propose that it
simply require the Secretary to meet certain numeric
reduction targets through 2020, leaving to her discretion the
means by which such targets are to be achieved. Id.
at 12-13. Plaintiffs' proffered timetable is as follows:
• 30% reduction from the current backlog of cases
pending at the ALJ level by December 31, 2017;
• 60% reduction from the current backlog of cases
pending at the ALJ level by December 31, 2018;
• 90% reduction from the current backlog of cases
pending at the ALJ level by ...