GAO Report Raises New ALJ Transfer Concerns

Washington

A new GAO report has raised additional concerns that the Department of Health and Human Services 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 believes 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, are putting pressure on 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.”