Tag Archives: Appellate Court

HOSPITALS VOW TO REFILE AFTER 340B SUIT REJECTED ON APPEAL

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , • Leave a comment

https://www.healthleadersmedia.com/finance/hospitals-vow-refile-after-340b-suit-rejected-appeal?utm_source=silverpop&utm_medium=email&utm_campaign=20180718_HLM_HP_resend%20(1)&spMailingID=13896483&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1441533371&spReportId=MTQ0MTUzMzM3MQS2

Image result for HOSPITALS VOW TO REFILE AFTER 340B SUIT REJECTED ON APPEAL

An appellate court decision dealt a major setback to hospitals unhappy with planned cuts to the Medicare drug reimbursement program.

KEY TAKEAWAYS

The appellate judges affirmed the district court’s dismissal for lack of subject-matter jurisdiction.

The AHA failed to fulfill the legal prerequisites to judicial review, according to the ruling.

The plaintiff has seven days to file a petition for the appellate court to rehear the matter en banc.

The American Hospital Association’s attempt to block $1.6 billion in cuts to the 340 Drug Pricing Program suffered a major setback Tuesday, when the D.C. Circuit Court sided with Health and Human Services.

The three-judge panel ruled that the lower court had properly dismissed AHA’s case because the association failed to fulfill the legal prerequisites to judicial review.

More specifically, AHA failed to adequately present the matter to HHS Secretary Alex Azar. This “presentment” threshold is the obstacle that tripped up the AHA challenge at the district court level, a decision Tuesday’s appellate ruling affirmed.

“When the plaintiffs filed this lawsuit, neither the hospital plaintiffs, nor any members of the hospital-association plaintiffs, had challenged the new reimbursement regulation in the context of a specific administrative claim for payment. Nor could they have done so, for the new regulation had not yet even become effective,” the appellate judges wrote. “Therefore, they had neither presented their claim nor obtained any administrative decision at all, much less the ‘final decision’ required under [the relevant law].”

The AHA, along with fellow plaintiffs the Association of American Medical Colleges and America’s Essential Hospitals, had argued that it met the presentment requirement by opposing the policy in writing during the rulemaking process.

Because the decision was based on a lack of subject-matter jurisdiction, it did not address the merits of AHA’s claims.

“We are deeply disappointed that the courts have once again failed to rule on the merits of our case,” the hospital groups said Tuesday in a statement.

The groups emphasized that the decision does not address whether they can obtain judicial review. It simply addresses when and how that review can be obtained.

“We will continue our fight to reverse these unwarranted cuts and protect access for patients, and we expect to refile promptly in district court,” the groups added.

 

 

 

Appeals court overturns ruling requiring HHS to clear Medicare appeals backlog by 2021

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , , • Leave a comment

http://www.beckershospitalreview.com/finance/appeals-court-overturns-ruling-requiring-hhs-to-clear-medicare-appeals-backlog-by-2021.html

Image result for medicare reimbursement appeals backlog

The U.S. Appeals Court for the District of Columbia on Friday overturned an order requiring HHS to clear its backlog of Medicare reimbursement appeals by the end of 2020.

On Dec. 5, 2016, U.S. District Judge James Boasberg granted a motion for summary judgment filed by the American Hospital Association in AHA v. Burwell — a lawsuit that centers on the Recovery Audit Contractor Program.

He ordered HHS to incrementally reduce the backlog of 657,955 appeals pending before the agency’s Office of Medicare Hearings and Appeals over the next four years, reducing the backlog by 30 percent by the end of 2017; 60 percent by the end of 2018; 90 percent by the end of 2019; and to completely eliminate the backlog by Dec. 31, 2020.

HHS filed a motion Dec. 15, 2016, asking the judge to reconsider his decision. HHS argued it would be impossible to reduce the appeals backlog on the schedule provided by the court without improperly paying claims, regardless of merit. In January, Judge Boasberg denied HHS’ motion for reconsideration.

In late January, HHS filed an appeal in the case, seeking to avoid the district court’s order enforcing the plan to clear the appeals backlog by the end of 2020.

On Friday, the appellate court sided with HHS.

Since HHS said it was impossible to lawfully comply with the district court’s order, the appellate court ruled it was “an error of law” and “an abuse of discretion” for the district court judge to order HHS to abide by the schedule to clear the Medicare appeals backlog.

“In sum, it was an abuse of discretion to tailor the mandamus relief without tackling the Secretary’s claims that lawful compliance would be impossible,” states the appellate court’s opinion.

The appellate court held that on remand the lower court should determine if compliance with the timetable to reduce the Medicare appeals backlog is impossible.