Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

American Hospital Association v. Burwell

United States District Court, District of Columbia

December 5, 2016

AMERICAN HOSPITAL ASSOCIATION, et al., Plaintiffs,
v.
SYLVIA M. BURWELL, in her official capacity as SECRETARY OF HEALTH AND HUMAN SERVICES, Defendant.

          MEMORANDUM OPINION

          JAMES E. BOASBERG United States District Judge.

         Two and 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.

         I. Background

         Understandably 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. 2016).

         Upon 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.

         For the 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.

         II. Analysis

         A. Plaintiffs' Proposals

         As 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) at 4-13.

         As to 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.

         Correctly 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 ...

Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.