POMONA, Calif., July 7, 2015 /PRNewswire/ -- Casa Colina Hospital and Centers for Healthcare filed suit on May 27, 2015 to require the U.S. Department of Health and Human Services (HHS) to resolve Medicare appeals within 90 days of submission as required by federal law. The suit, which was filed in the U.S. District Court for the Central District of California, requests the court to order HHS to address Casa Colina's pending appeals, which have been languishing for as long as two years, depriving Casa Colina of needed funding.
"The lengthy delay in addressing our appeals could threaten our ability to serve the rehabilitation needs of Medicare beneficiaries in California," stated Felice Loverso, Ph.D., President and CEO of Casa Colina. "With this suit, Casa Colina intends to hold Medicare to the rules established by Congress."
When the Medicare program denies payment for a claim for services, the statute entitles providers and patients to a hearing before an administrative law judge (ALJ). The statute requires the ALJ to hold a hearing and issue a decision within 90 days. HHS has routinely missed this deadline. However, because it has permitted its auditors to review and deny hundreds of thousands of claims without adequate oversight by HHS, the backlog has become so extreme that HHS has stopped assigning new appeals to ALJs for 28 months.
Casa Colina's experience with its past HHS appeals shows that most of the claim denials are invalid. During the appeal process, HHS recoups Medicare payments and holds them while providers often wait years for their appeals to be heard instead of the 90-day requirement. According to current health care sector data, Inpatient Rehabilitation Facilities, such as Casa Colina, typically win approximately 80 percent of their appeals before ALJs. The ALJ appeal backlog means that HHS will continue to retain funds that rightfully belong to the hospitals that treat Medicare beneficiaries. To date, HHS holds more than $1.1 million in Casa Colina's funds for services already provided. This action has created a financial burden to Casa Colina that could threaten its ability to provide much-needed patient care to the most vulnerable Medicare beneficiaries.
Casa Colina is represented by Powers Pyles Sutter & Verville, PC, a Washington, DC law firm that focuses on health and rehabilitation issues. Ronald S. Connelly is the counsel of record.
About Casa Colina Hospital and Centers for Healthcare
Casa Colina was founded in 1936 and provides inpatient and outpatient hospital rehabilitation services to people of all ages with neurological and/or orthopedic conditions. For more information, visit www.casacolina.org.
SOURCE Casa Colina Hospital and Centers for Healthcare