Revenue Cycle

OIG issues review of Medicare appeals at the Administrative Law Judge level

Recovery Auditor Report, November 29, 2012

On November 15, the OIG issued a review of ALJ appeals decided in fiscal year 2010. The study was conducted by interviewing ALJs and other staff, qualified independent contractors (which administer the second level of appeal), and CMS staff. In addition, the OIG analyzed CMS policies, procedures, documents and data on CMS participation in ALJ appeals.

The review found that when CMS participated in appeals, ALJ decisions were less likely to be favorable to appellants. In addition, the OIG raised concerns about the acceptance of new evidence and the organization of case files.

View the OIG report.

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