Medicare Beneficiaries Fight ALJ Transfer

Phoenix

Two Medicare beneficiaries and a national organization seeking certification as a class action have filed a lawsuit against CMS challenging recent changes to the Medicare appeals process.

The complaint states that under Medicare’s new appeals process — which transferred administrative law judges from the Social Security Administration to HHS in July — it is nearly impossible for a beneficiary to get an in-person hearing. The ALJ transfer was mandated by the Medicare Modernization Act.

Eleanor Webber, Judith Schneider and The Gray Panthers Project Fund, a national organization of Medicare beneficiaries, filed the complaint last month in U.S. District Court in Arizona, claiming they were deprived of a fair and impartial hearing. Webber and Schneider received medical treatment that was determined to be not covered by Medicare, and their appeals are now at the ALJ stage, according to the complaint.

HHS currently has four physical hearing location sites, compared to 141 when appeals were handled by the SSA. While HHS said its use of video-conferencing in more than 1,000 cities would speed up the process, the lawsuit argues it denies beneficiaries a right to a fair hearing.

Among other things, the complaint asks for a permanent injunction requiring CMS to give class action members an opportunity to receive in-person ALJ hearings.