Health Information Management

AHA loses lawsuit over Recovery Auditor appeals

HIM-HIPAA Insider, January 12, 2015

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The District of Columbia federal district court dismissed a lawsuit December 18, 2014, filed by the American Hospital Association (AHA) against HHS for excessive and inappropriate Recovery Auditor denials, according to AHA News.The AHA announced that it may appeal the court’s decision.

 
AHA fought back against the HHS’ December 2013 decision to suspend the assignment of Administrative Law Judges (ALJ) to appeals hearings. This suspension not only contradicts the requirement that the ALJ review an appeal and issue a decision within 90 days, but created an appeals backlog.
 
U.S. District Court Judge James E. Boasberg dismissed the lawsuit because he believed courts should not intervene in the Recovery Auditor appeals process at a time when HHS and Congress are working toward a solution to the appeals delay. In addition, Judge Boasberg ruled that the delay is not so outstanding that it requires judicial intervention, according AHA News.
 
Baxter Regional Medical Center in Mountain Home, Arkansas; Covenant Health in Knoxville, Tennessee; and Rutland (Vermont) Regional Medical Center joined AHA in filing the suit. When the lawsuit was filed in May 2014, the three covered entities had more than $8.9 million in combined pending Recovery Auditor appeals, AHA News reported.



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