From: The Honorable Todd Rokita
Sent By:
Date: 4/29/2014

Dear Colleague:

As you may know, the Office of Medicare Hearings and Appeals (OMHA), which administers appeal hearings for the Medicare program, recently announced that it would suspend the ability of providers to have their appeals heard by an administrative law judge (ALJ). The decision was made as a result of a massive backlog of appeals already awaiting an ALJ hearing, which by OMHA’s own admission has grown from 92,000 to over 460,000 in just the last two years.

This backlog has forced providers to wait 16 months or more for a payment appeals hearing, which jeopardizes cash flow for honest providers. Making matters worse, many providers, particularly in the orthotics and prosthetics field, are small businesses who do not have the luxury of waiting months for payment of services legitimately rendered.

With over half of all rulings at the ALJ level falling in favor of the provider, OMHA’s decision to completely abandon appeal referrals to ALJ’s constitutes an explicit violation of the statutory requirement for an ALJ hearing within 90 days of the date when the appeal request was filed.  In other words, this decision will be devastating to already struggling providers and the millions of Medicare beneficiaries they serve.

That’s why we’re asking you to join us in sending a letter to the Department of Health and Human Services asking them to grant providers overdue relief from audits while a long-term solution to the ever-growing backlog of appeals is addressed.

If you have any questions, please do not hesitate to contact Kalina Bakalov on Congresswoman Tammy Duckworth’s staff at (202) 225-3711 or Tom Borck on Congressman Todd Rokita’s staff at or 202-225-5037.


                     TAMMY DUCKWORTH                                                   TODD ROKITA

                      Member of Congress, IL-08                                            Member of Congress, IN-04