ALJ Transfer to HHS Jeopardized, GAO Says

Washington

A timely transfer of administrative law judges (ALJs) from the Social Security Administration (SSA) to the Department of Health and Human Services (HHS) is in jeopardy, according to a report by the General Accountability Office (GAO).

Currently, the SSA has about 950 judges located in regional offices nationwide. All spend at least some portion of their time working on Medicare appeals and have a support staff of about 5,200. About 34 ALJs oversee what Medicare calls “big box” cases involving 30 or more beneficiaries. Those cases, according to HHS, account for a substantial portion of Medicare dispositions.

The Medicare Modernization Act mandates the judges be transferred from the SSA to HHS no later than Oct. 1, 2005. Next year, HHS plans to hire 50 ALJs with a reduced support staff, though that number could increase with additional funding.

The GAO criticized HHS’ plan, claiming it omits important details. “Failure to successfully implement one element of the plan, such as the development of a geographic distribution plan to ensure appellants’ appropriate access to ALJs throughout the country, could derail the transfer,” the GAO said.

“Despite the fact that the independence of ALJs is critical to ensuring due process to [claims] appellants,” the report explained, “the plan is silent on what steps will be taken to shield ALJs from real or perceived external pressures, including pressure from elsewhere in HHS, which is tasked with overseeing the Medicare program.”

HHS responded by saying contingency plans are not required for this issue, but “the decisional independence is of paramount importance, and [HHS] will take steps to ensure that this occurs.”