On January 4, 2017, the court in the American Hospital Association (AHA) v. Burwell litigation denied HHS’s motion to reconsider, which means that HHS must comply with the court’s timeline to eliminate the Medicare appeals backlog by December 31, 2020.  The AHA filed suit against HHS in 2014, wherein AHA sought mandamus relief to compel HHS to meet its statutory deadline for administrative review of denial of claims for Medicare reimbursement.  As previously reported, on December 5, 2016, the U.S. District Court for the District of Columbia granted AHA’s motion for summary judgment.  

Adopting AHA’s proposed deadlines to reduce the appeals backlog, the court ordered HHS to:

• Reduce the appeals backlog by 30 percent by the end of 2017;
• Reduce the appeals backlog by 60 percent by the end of 2018;
• Reduce the appeals backlog by 90 percent by the end of 2019; and
• Completely eliminate the appeals backlog by December 31, 2020.

The order further provided that: (i) HHS must file status reports with the court every 90 days; and (ii) AHA may move for a default judgment or enforce the writ of mandamus against HHS should HHS be in default of the court’s order on January 1, 2021.  

In response to the court’s December 5, 2016 ruling, HHS filed a motion to reconsider on December 15, 2016.  HHS argued that reconsideration was “[w]arranted to correct a clear error in the Court’s ruling and to prevent manifest injustice.” 

Specifically, HHS contended that it would have to “[p]ay pending claims without regard to their merit” to achieve the court’s deadlines for percentage reductions in the Medicare appeals backlog.  HHS further argued that such a result would violate HHS’s obligation to protect the Medicare Trust Funds, which are “[r]eserved by statute for the payment of meritorious claims for Medicare-covered services to the elderly and disabled and associated administrative costs.”  HHS concluded its motion to reconsider by arguing that “[b]ecause [HHS] is caught between two statutory mandates that are incompatible given HHS’s present resources and authorities, the Court should have left resolution of the conflict to the Secretary’s discretion and allowed the Secretary to continue to address the backlog through the administrative measures [it] deems appropriate.”

As noted, on January 4, 2017, the court denied HHS’s motion to reconsider, which means that HHS must comply with the court’s timeline to eliminate the Medicare appeals backlog by December 31, 2020.  Although the court was “[n]ot unsympathetic to Defendant’s plight,” it found that “[HHS’s] argument that [it] cannot comply with both the reduction targets and [its] statutory obligation to protect the Medicare Trust Funds is not new; it was twice urged in prior briefing.”  The court ultimately concluded that HHS had failed to meet the “stringent standard” to alter or amend the court’s judgment.  

HHS implied in its motion to reconsider that it will appeal the court’s decision.