Am. Hosp. Ass’n v. Burwell — Feb. 2016 (Summary)

MEDICARE – TIMELY CLAIMS PROCESSING

Am. Hosp. Ass’n v. Burwell
No. 15-5015 (D.C. Cir. Feb. 9, 2016)

The United States Court of Appeals for the District of Columbia Circuit held that the Secretary of Health and Human Services is statutorily required to process Medicare claims appeals in a timely fashion and hospitals have the right to demand compliance by seeking a writ of mandamus ordering the Secretary to comply. Hospitals filed suit against the Secretary of HHS because of a massive backlog of undecided claims. The hospitals have a significant amount of money tied up during the appeals process and the statutory period within which the appeal should have been resolved has expired. The hospitals are unable to do renovations or buy needed materials such as ICU beds not knowing the status of their funding. The district court held that the writ was unwarranted because the political branches were working on a resolution to the problem. The case moved to the United States Court of Appeals, which stopped short of actually granting the writ. The Court of Appeals remanded the matter to the lower court for consideration of whether “compelling equitable grounds” exist to issue a writ of mandamus at this time. The court’s opinion strongly suggested, however, that if Congress and/or the Secretary do not solve this problem soon, a writ of mandamus will be inevitable.