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Now that the HHS Office of Medicare Hearings and Appeals (OMHA) has cleared out its backlog of appeals, the bad old days of waiting four or five years to learn the fate of a Medicare claim denial are gone. Attorney Jessica Gustafson said administrative law judges (ALJs) now decide cases within the 90-day deadline required by law. But she and other attorneys worry that timely decisions will again fall by the wayside in the wake of HHS’s March 27 announcement that it’s cutting an additional 10,000 employees, reducing the number of regional offices and restructuring the department. OHMA, the Departmental Appeals Board (DAB) and the HHS Office for Civil Rights (OCR) will soon be grouped together under a new position, the Assistant Secretary for Enforcement, to fight fraud, waste and abuse in federal health programs, HHS said.

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The RIFs are a response to the Feb. 11 executive order on “Implementing the President’s Order on ‘Department of Government Efficiency’ Workforce Optimization Initiative,” said attorney Christina McKinley, with Blank Rome. Section three specifies that agencies aren’t permitted to hire more than one employee for every four employees who leave. “This is all part of the DOGE coming in and talking to agencies and seeing if agencies should be restructured,” she noted. “If there are significant reductions in force, then necessarily you are losing some of that agency expertise or ALJ expertise.”

Bittinger predicts a future with fewer people who pursue or stay in government jobs that once seemed like safe, stable employment. “Losing the expertise aligns with the new era of administrative law” unfolding in the wake of the U.S. Supreme Court decision in Loper Bright Enterprises et al. v. Raimondo, Secretary of Commerce, et al., which overturned Chevron deference, McKinley said. Now that Chevron deference is gone, a lot of regulatory disputes will be decided by judges who are “incredibly smart people but not experts in the field,” she noted. “A court is allowed to give the agency’s interpretation weight, but it’s not binding.”

The great unknown is how health industry stakeholders will move forward if HHS regulations and guidance are slower or less predictable, McKinley said. “You can’t be at a standstill,” she noted. “You have to tell the client to operate from what you think is a legally supportable position.” It’s a matter of their risk tolerance. But some things are just a numbers game and that takes it back to ALJs, for example. “If we don’t have enough ALJs, how do we move this stuff through the system? That’s a real concern. The courts and the ALJs are incredibly overtaxed,” McKinley said.

To read the full article, please click <a href="https://compliancecosmos.org/medicare-appeals-backlog-anticipated-new-hhs-enforcement-position-job-cuts?authkey=2b19f8c449393da12068a65e405de0981425e0c970028d0c9635637c591a3e23&amp;_zs=esOUL1&amp;_zl=Wpuj7">here</a>.

"Medicare Appeals Backlog Is Anticipated with New HHS Enforcement Position, Job Cuts," by Nina Youngstrom was published in <a href="https://compliancecosmos.org/report-medicare-compliance-volume-34-number-13-april-07-2025">Report on Medicare Compliance Volume 34, Number 13</a> on April 7, 2025.

Medicare Appeals Backlog Is Anticipated with New HHS Enforcement Position, Job Cuts

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Medicare Appeals Backlog Is Anticipated with New HHS Enforcement Position, Job Cuts

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