GAO Report Raises New Concerns About ALJ Transfer

WASHINGTON–A new GAO report has raised additional concerns that
HHS has not taken adequate steps to ensure fair and accessible
appeals for denied claims.

The Medicare appeals process, which was formerly under the
jurisdiction of the Social Security Administration, was transferred
to HHS in July as required by the MMA.

In the Aug. 1 report, the GAO criticized HHS’ handling of the
process, claiming that it offers limited access to in-person
hearings, is suffering staffing shortages, has not yet fully
implemented a case-tracking system and has not established a
contingency plan for the transfer. HHS has four hearing location
sites–Arlington, Va.; Miami; Cleveland, Ohio; and Irvine,
Calif.–compared to 141 when appeals were handled by Social
Security.

In place of in-person hearings, HHS is using videoconferencing
technology in more than 1,000 cities for most appeals. While HHS
claims this will speed up the process, the GAO is concerned about
the agency’s reliance on this technology.

Sens. Charles Grassley, R-Iowa, and Max Baucus, D-Mont., who had
expressed concerns prior to the move (see HomeCare
Monday, April 4), are putting pressure on the HHS to take
action.

“This new report says that many of the same shortcomings
described last fall still exist and threaten the entire appeals
process,” Grassley said. “We need to stay on top of the transfer
process to make sure the current failures by the Department of
Health and Human Services do not continue. The new system needs to
work in the interest of beneficiaries, not against them.”

To view the GAO report, click here.