Medicare Appeals Problems Concern Senate Finance Committee Leaders

Max Baucus (D-Mont) and Chuck Grassley (R-Iowa) sent a letter, recently to HHS Secretary Mike Leavitt voicing their concern about problems in the Medicare Hearings and Appeals office according to a report by CQ Healthbeat. A July report by the HHS office of Inspector General was cited. A number of problems were found at OMHA.

OMHA was established by the 2003 Medicare law for conducting administrative appeals heard by the Social Security Administration. The report says that 35 percent of appellants who were interviewed by HHS OIG had stated that hearings through video teleconference were not allowed to them.

In addition, there was no guidance manual or standardized script which could provide direction to workers when hearing options were to be presented to appellants. OMHA also often did not meet the requirement to reach decisions within 90 days. This happened in 15 percent of the appeals. According to OMHA officials the office had taken steps to address the problems in the report.