Recovery Audit Contractor (RAC)

Recovery Audit Contractor (RAC) / en Mon, 28 Apr 2025 05:50:33 -0500 Thu, 05 Oct 23 06:15:00 -0500 AHA Expresses Concerns with Veterans Affairs’ Third-party Audit and Appeals Process /lettercomment/2023-10-05-aha-expresses-concerns-veterans-affairs-third-party-audit-and-appeals-process <div class="container"> <div class="row"> <div class="col-md-8"> October 4, 2023 &nbsp; The Honorable Shereef Elnahal, M.D. Under Secretary for Health Department of Veterans Affairs 810 Vermont Avenue, N.W. Washington, DC 20420 </div> <div class="col-md-4"> <div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2023/10/AHA-Expresses-Concerns-with-Veterans-Affairs-Third-party-Audit-and-Appeals-Process.pdf" target="_blank" title="Click here to download the AHA Expresses Concerns with Veterans Affairs’ Third-party Audit and Appeals Process letter PDF.">Download the Letter PDF</a></div> </div> </div> <div class="row"> <div class="col-md-8"> Submitted Electronically Re: Cotiviti Audit Process Dear Under Secretary Elnahal: On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) recognizes the importance of fiscal stewardship and the fiduciary responsibility that the Department of Veterans Affairs (VA) has in assessing improper payments. Indeed, the Payment Integrity Information Act of 2019 put in place government-wide requirements for agencies to identify and reduce improper payments. Accordingly, the VA contracted with Cotiviti to support the requirements outlined in the act and perform recovery audits of claims from fiscal year (FY) 2018 through FY 2023. We applaud the VA’s efforts to conduct recovery audits in order to return overpayments in accordance with the law. However, our members have expressed significant concerns about Cotiviti’s audit and appeals process, including its inadequate appeals procedures, the scope of audits being performed and the untenable timelines that are being executed. It is adding confusion and unnecessary administrative burden to a workforce that is already significantly strained. Therefore, we urge the VA to issue proposed rulemaking not only to allow for public input but also to formalize clear standards and expectations governing the audit and appeals processes. <h2>Lack of a Defined Audit and Appeals Process</h2> We are very concerned about the general lack of information on the audit process, as well as lack of follow-through on promised public input. For example, the VA website states that: “Before the start of each new audit, Cotiviti will post a preliminary audit plan to their public-facing website for 30 calendar days for public review and comment. VA and Cotiviti will review comments and make appropriate adjustments before the plan is finalized. The final audit plans will be posted to Cotiviti’s public website before each audit begins.”<a href="#fn1">1</a> However, Cotiviti has posted no information to its website, despite the fact that the audits began well over a year ago. In addition, a Cotiviti Frequently Asked Question indicates: “The type of review is determined by the claim type and audit plan. All audit plans Cotiviti develops must first be approved by the Office of Community Care and will be posted on <a href="www.cotiviti.com/varac" target="_blank">Cotiviti’s Recovery Audit Contract (RAC) provider website</a> for a 30-day comment period. Once the audit plan receives final approval, it will be posted to www.cotiviti.com/varac prior to Cotiviti initiating an audit.”<a href="#fn2">2</a> However, this is a provider portal and is not public facing; it is therefore unclear how it could allow for public comment. Indeed, other federal agencies have statements of work and processes posted on their public-facing websites. They outline the timelines for notices and appeals, identify independent third parties that support the appeals process, and specify the scope of audit procedures. Additionally, the processes are defined by the agency, not the third party responsible for executing the audit. This reinforces the role of the agency in determining the scope of the appeals, the process, and ultimate disposition of claims and denials, providing clear expectations for all parties involved. Rulemaking is necessary for the VA to do the same for this program. <h2>Inadequate Appeals Process</h2> We are also concerned that the appeals process is inadequate. Specifically, based on the limited information that is available, Cotiviti audits appear only to have one opportunity for appeal after the initial denial. However, other federal audit programs, such as those conducted on behalf of the Medicare program, have at least three opportunities for appeal. Cotiviti also utilizes independent entities to conduct certain levels of appeals, helping ensure opportunities for objective review. Therefore, we recommend that as part of rulemaking, the VA propose both to create multiple levels of appeals and also to utilize parties unaffiliated with the VA and third-party auditor to conduct some of these appeals. <h2>Scope of Reviews</h2> Members have reported to us that the Cotiviti audits have included medical necessity reviews. Yet, the VA website indicates that the scope of the reviews is to be limited to claim reimbursement rates, reimbursement of non-covered or unauthorized services, incorrectly coded services and duplicate services.<a href="#fn3">3</a> In addition, we note that medical necessity reviews are subjective and a matter of professional medical judgment. As such, they are particularly negatively affected by the lack of an adequate, independent appeals process, as noted above. Members also have reported that audits have included Community Care Network (CCN) claims. Yet, per the VA’s website, the scope of the audits is intended to exclude these claims.<a href="#fn4">4</a> This is because CCN contracts include their own requirements for recovery/recapture audits. As such, it appears that Cotiviti is conducting audits beyond the scope of its authority, meaning some organizations may be receiving claims denials and letters of indebtedness that are inappropriate. Therefore, as part of the rulemaking process, we also recommend that the VA clarify that these audits are limited to coding and technical reviews, per its website. <h2>Delays in Timely Notifications</h2> Finally, our members have expressed concern regarding the timelines for notification and appeals. For example, many have received letters (either Notices of Indebtedness or denial letters) with 30-day windows to appeal but did not receive these letters until over 14 days into the 30-day window. Providing two weeks for organizations to pull records and package appeals is operationally untenable and inconsistent with timelines established by other federally funded programs. Therefore, we recommend that the VA establish, in rulemaking, a 60-day window for appeals that begins on the date of letter receipt. This will ensure that providers have adequate time to gather and transmit the appropriate information. Conversely, some providers have appealed claim denials but did not receive replies for excessively long time periods. For example, some organizations received letters of indebtedness in 2022 and submitted appeals documentation within 30 days, but still have not received notification of disposition, approval or denial. In general, organizations that have received replies indicated that it took over 18 months. This is simply too long for such matters to be outstanding at an organization and speaks to the need for clarity on timelines for notifications, appeals and determinations. As such, as part of its formal rulemaking process, we urge the VA to propose timelines for appeals disposition. We appreciate your consideration of our requests. Please contact me if you have questions or feel free to have a member of your team contact Jennifer Holloman, AHA’s senior associate director of policy, at <a href="mailto:jholloman@aha.org?subject=RE: AHA Expresses Concerns with Veterans Affairs’ Third-party Audit and Appeals Process letter">jholloman@aha.org</a>, or Joanna Hiatt Kim, AHA’s vice president of payment policy, at <a href="mailto:jkim@aha.org?subject=RE: AHA Expresses Concerns with Veterans Affairs’ Third-party Audit and Appeals Process letter">jkim@aha.org</a>. Sincerely, /s/ Ashley Thompson Senior Vice President Public Policy Analysis and Development <hr> <ol> <li id="fn1"><a href="https://www.va.gov/COMMUNITYCARE/revenue_ops/provider_payments.asp" target="_blank">https://www.va.gov/COMMUNITYCARE/revenue_ops/provider_payments.asp</a></li> <li id="fn2"><a href="https://info.cotiviti.com/hubfs/varac/Cotiviti_VA_RAC_FAQs_12.16.21.pdf" target="_blank">https://info.cotiviti.com/hubfs/varac/Cotiviti_VA_RAC_FAQs_12.16.21.pdf</a></li> <li id="fn3"><a href="https://www.va.gov/COMMUNITYCARE/revenue_ops/provider_payments.asp" target="_blank">https://www.va.gov/COMMUNITYCARE/revenue_ops/provider_payments.asp</a></li> <li id="fn4"><a href="https://www.va.gov/COMMUNITYCARE/revenue_ops/provider_payments.asp" target="_blank">Ibid.</a></li> </ol> </div> <div class="col-md-4"> <a href="/system/files/media/file/2023/10/AHA-Expresses-Concerns-with-Veterans-Affairs-Third-party-Audit-and-Appeals-Process.pdf" target="_blank" title="Click here to download the AHA Expresses Concerns with Veterans Affairs’ Third-party Audit and Appeals Process letter PDF."><img alt="AHA Expresses Concerns with Veterans Affairs’ Third-party Audit and Appeals Process letter page 1." data-entity-type="file" data-entity-uuid="8c6c6813-a510-4f36-94fd-39b6266ed50e" src="/sites/default/files/inline-images/Page-1-AHA-Expresses-Concerns-with-Veterans-Affairs-Third-party-Audit-and-Appeals-Process.png" width="692" height="900"></a> </div> </div> </div> Thu, 05 Oct 2023 06:15:00 -0500 Recovery Audit Contractor (RAC) Litigation /legal/litigation This page contains materials related to AHA’s current and active policy-related litigation. <hr /> <div class="col-md-12 cc_tabs">Get CertifiedRecertify</div> --&gt; <div class="tabcontent" id="General"> <div class="tabcontent" id="General"> <ul class="a-container"> <li class="a-items"> No Surprises Act Regulation <div class="a-content"> <a href="/legal-documents/2021-12-10-hospital-and-physician-groups-file-lawsuit-over-no-surprises-act-final" target="_blank">AHA, AMA and Others on No Surprises Act Rule That Jeopardizes Patient Access to Care</a> <ul> <li><a href="/system/files/media/file/2021/12/Opposition-to-Briefing-Schedule.pdf">AHA, AMA, Hospitals/Physicians Oppose Govt’s proposed briefing schedule (Dec. 15, 2021) </a></li> <li><a href="/system/files/media/file/2021/12/Mot-to-Establish-Briefing-Schedule.pdf">Govt’s Motion to establish briefing schedule (Dec. 14, 2021)</a></li> <li><a href="/system/files/media/file/2021/12/Hospital-Association-Amicus-Brief.pdf">National Hospital Associations amicus brief supporting AHA’s No Surprises Act legal challenge (Dec. 15, 2021)</a></li> <li><a href="/system/files/media/file/2021/12/AMA-v-HHS-As-Filed-Complaint.pdf">Complaint for Declaratory and Injunctive Relief</a> (December 9, 2021)</li> <li><a href="/system/files/media/file/2021/12/AMA-v-HHS-As-Filed-Stay-Motion-and-Brief.pdf">Plaintiffs Motion for Stay Pending Judicial Review, Or in the Alternative, For Summary Judgment</a> (December 9, 2021)</li> <li><a href="/system/files/media/file/2021/12/AMA-v-HHS-As-Filed-Sexton-Declaration.pdf">Declaration of Bethany Sexton (Renown Health) in Support of Plaintiffs Motion for Preliminary Injunction</a> (December 9, 2021)</li> <li><a href="/system/files/media/file/2021/12/AMA-v-HHS-As-Filed-Rossi-Declaration.pdf">Declaration of Catherine M. Rossi (UMass Memorial Health) in Support of Plaintiffs’ Motion for Stay Pending Judicial Review, or in the Alternative, a Preliminary Injunction</a> (December 9, 2021)</li> </ul> </div> <ul class="a-container"> <li class="a-items"> 340B Contract Pharmacy – Intervention <div class="a-content"> NOVO NORDISK v Cochran <ul> <li><a href="/2021-06-24-amicus-brief-novo-nordisk-v-cochran-re-340b-contract-pharmacy-intervention">Amicus Brief NOVO NORDISK v Cochran </a>(June 22, 2021)</li> <li><a href="/legal-documents/2021-03-31-reply-support-motion-intervene-novo-nordisk-v-cochran-march-29-2021">Reply in Support of Motion to Intervene </a>(March 29, 2021)</li> <li><a href="/legal-documents/2021-03-31-response-motion-intervene-novo-nordisk-v-cochran-march-22-2021">Response to Motion to Intervene </a>(March 22, 2021)</li> <li><a href="/legal-documents/2021-03-27-notice-and-memorandum-support-motion-intervene-sanofi-aventis-vs-hhs">Motion and Memorandum in Support of Motion to Intervene </a>(March 2, 2021)</li> </ul> &nbsp; SANOFI-AVENTIS v HHS <ul> <li><a href="/legal-documents/2021-11-05-court-opinion-sanofi-aventis-us-llc-and-novo-nordisk-challenges-340b">Court Opinion in Sanofi-Aventis U.S., LLC, and Novo Nordisk challenges to 340B Contract Pharmacies Obligations </a>(November 5, 2021)</li> <li><a href="/legal-documents/2021-03-29-associations-reply-support-motion-intervene-sanofi-aventis-vs-hhs-march">Associations’ Reply in Support of Motion to Intervene </a>(March 29, 2021)</li> <li><a href="/legal-documents/2021-03-26-response-motion-intervene-sanofi-aventis-vs-hhs-march-22-2021">Response to Motion to Intervene </a>(March 22, 2021)</li> <li><a href="/legal-documents/2021-03-27-notice-and-memorandum-support-motion-intervene-sanofi-aventis-vs-hhs">Notice and Memorandum in Support of Motion to Intervene </a>(March 3, 2021)</li> </ul> &nbsp; AstraZeneca v. Cochran <ul> <li><a href="/system/files/media/file/2021/05/05-04-21-Docket-No-54-AHA-et-al-Amicus-Brief.PDF">Amicus Brief of Associations in Support of the Government</a> (May 4, 2021)</li> <li><a href="/system/files/media/file/2021/05/05-04-21-Docket-No-56-Gov-Brief-in-Support-of-MTD_MSJ.PDF">Government’s Brief in Support of Motion to Dismiss or, Alternatively, Motion for Summary Judgment and Opposition to Plaintiff’s Motion for Summary Judgment</a> (May 4, 2021)</li> <li><a href="/legal-documents/2021-03-27-associations-reply-support-motion-intervene-astrazeneca-v-cochran-march">Associations’ Reply in Support of Motion to Intervene </a> (March 19, 2021)</li> <li><a href="/legal-documents/2021-03-27-astrazenecas-opposition-motion-intervene-astrazeneca-v-cochran-march-12">AstraZeneca’s Opposition to Motion to Intervene </a> (March 12, 2021)</li> <li><a href="/amicus-brief/2021-03-27-governments-opposition-motion-intervene-astrazeneca-v-cochran-march-12-2021">Government’s Opposition to Motion to Intervene </a> (March 12, 2021)</li> <li><a href="/system/files/media/file/2021/03/motion-to-intervene-astrazeneca-v-cochran-2-26-21-340b-contract-pharmacy-intervention.pdf">Motion to Intervene – AstraZeneca v. Cochran</a> (Feb. 26, 2021)</li> </ul> &nbsp; Eli Lilly v. Cochran <ul> <li><a href="/legal-documents/2021-11-01-court-decision-lilly-challenge-october-29-2021">Court Decision on the Lilly Challenge </a>(October 29, 2021)</li> <li><a href="/legal-documents/2021-11-01-court-order-lilly-challenge-october-29-2021">Court Order in the Lilly Challenge </a>(October 29, 2021)</li> <li><a href="/legal-documents/2021-03-26-associations-reply-support-motion-intervene-eli-lilly-v-cochran-march-19">Amicus Brief Eli Lilly v Cochran </a>(June 23, 2021)</li> <li><a href="/legal-documents/2021-03-26-associations-reply-support-motion-intervene-eli-lilly-v-cochran-march-19">Associations’ Reply in Support of Motion to Intervene </a>(March 19, 2021)</li> <li><a href="/legal-documents/2021-03-26-governments-opposition-motion-intervene-eli-lilly-v-cochran-march-9-2021">Government’s Opposition to Motion to Intervene </a>(March 9, 2021)</li> <li><a href="/system/files/media/file/2021/02/motion-to-intervene-340B-contract-pharmacy-2-19-21.pdf">Motion to Intervene </a> (Feb. 19, 2021)</li> <li><a href="/system/files/media/file/2021/02/memorandum-in-support-of-motion-to-intervene-340b-contract-pharmacy-2-19-21.pdf">Memorandum in Support of Motion to Intervene </a> (Feb. 19, 2021)</li> </ul> <h4>Additional Drug Manufacturers Challenges to 340B Contract Pharmacy Obligations</h4> Novartis/United Therapeutics v ESPINOSA <ul> <li><a href="/legal-documents/2021-11-05-court-order-novartisunited-therapeutics-challenges-340b-contract">Court Order Novartis/United Therapeutics Challenges to 340B Contract Pharmacies Obligations </a> (Nov.5, 2021)</li> <li><a href="/legal-documents/2021-11-05-court-opinion-novartisunited-therapeutics-challenges-340b-contract">Court Opinion in Novartis/United Therapeutics Challenges to 340B Contract Pharmacies Obligations </a> (Nov.5, 2021)</li> </ul> </div> <ul class="a-container"> <li class="a-items"> 340B Contract Pharmacy <div class="a-content"> <a href="/system/files/media/file/2021/02/order-granting-motion-to-dismiss-re-340b-contract-pharmacy-2-17-21.pdf">Order Granting Motion to Dismiss</a> (Feb. 17, 2021) <a href="/system/files/media/file/2021/02/plaintiffs-response-order-show-cause-opposition-to-defendants-motion-dismiss-reply-support-plaintiffs-motion-for-preliminary-injunction-340b-contract-pharmacy-1-25-21.pdf">Plaintiffs' Response to Order to Show Cause, Opposition to Defendants' Motion to Dismiss, and Reply in Support of Plaintiffs' Motion for a Preliminary Injunction</a> (Jan. 25, 2021) <a href="/system/files/media/file/2021/02/order-to-show-cause-re-dismissal-for-lack-of-subject-matter-jurisdiction-340b-contract-pharmacy-1-13-21.pdf">Order to show Cause RE: Dismissal for Lack of Subject-Matter Jurisdiction</a> (Jan. 13, 2021) <a href="/system/files/media/file/2020/12/associations-hospitals-complaint-compel-hhs-action-address-340b-contract-pharmacy-issue-12-11-20.pdf">Associations and Hospitals Complaint to compel HHS Action to Address 340B Contract Pharmacy Issue</a> (Dec. 11, 2020) <ul> <li><a href="/system/files/media/file/2020/12/associations-hospitals-motion-preliminary-injunction-hhs-action-to-address-340b-contract-pharmacy-issue%20-12-11-20.pdf">Associations and Hospitals Motion for Preliminary Injunction </a>(Dec. 11, 2020)</li> <li><a href="/system/files/media/file/2020/12/summons-re-associations-hospitals-complaint-compel-hhs-action-address-340b-contract-pharmacy-issue-12-11-20.pdf">Summons to HHS </a> (Dec. 11, 2020)</li> </ul> </div> </li> <li class="a-items"> Disclosure of Negotiated Charges <div class="a-content"> <a href="/legal-documents/2020-12-24-reply-support-appellants-emergency-motion-stay-december-24-2020">Reply in Support of Appellants’ Emergency Motion for Stay</a> (December 24, 2020) <a href="/system/files/media/file/2020/12/2020-12-23-Appellee-US-Opposition-to-Emergency-Motion-to-Stay.pdf">Appellee U.S. Opposition to Emergency Motion to Stay</a> (December 23, 2020) <a href="/legal-documents/2020-12-21-hospitals-emergency-motion-stay-re-disclosure-negotiated-rates">Hospitals’ Emergency Motion for Stay </a>(December 21, 2020) <ul> <li><a href="/system/files/media/file/2020/12/hospitals-emergency-motion-for-stay-disclosure-of-negotiated-rates-12-21-2020-ex-1.pdf">Exhibit 1</a></li> <li><a href="/system/files/media/file/2020/12/hospitals-emergency-motion-for-stay-disclosure-of-negotiated-rates-12-21-2020-ex-2.pdf">Exhibit 2</a></li> <li><a href="/system/files/media/file/2020/12/hospitals-emergency-motion-for-stay-disclosure-of-negotiated-rates-12-21-2020-ex-3.pdf">Exhibit 3</a></li> </ul> <a href="/legal-documents/2020-10-02-hospital-group-responds-governments-notice-about-recent-guidance-oct-2">Hospital Group Responds to Government’s Notice About Recent Guidance </a>(October 2, 2020) <a href="/legal-documents/2020-10-02-government-notifies-court-recently-released-guidance-negotiated-charges">Government Notifies Court of Recently Released Guidance on Negotiated Charges Rule Implementation </a>(October 1, 2020) <a href="/legal-documents/2020-10-02-government-responds-hospital-group-letter-executive-order-oct-1-2020">Government Responds to Hospital Group Letter on the Executive Order </a>(October 1, 2020) <a href="/legal-documents/2020-09-28-hospital-group-notifies-court-recent-price-transparency-executive-order">Hospital Group Notifies Court of Recent Price Transparency Executive Order </a>(September 25, 2020) <a href="/legal-documents/2020-09-28-govt-responds-hospital-groups-previous-notice-court-re-additional">Govt. Responds to Hospital Groups’ Previous Notice to the Court about Additional Disclosure Required In 2021 IPPS Final Rule </a>(September 25, 2020) <a href="/legal-documents/2020-09-21-hospital-group-notifies-court-relevant-supplemental-authority-re">Hospital Group Notifies Court of Relevant Supplemental Authority </a>(September 21, 2020) <a href="/legal-documents/2020-08-28-hospital-groups-reply-government-re-disclosure-negotiated-charges-august">Hospital Groups Reply to Government </a>(August 28 2020) <a href="/legal-documents/2020-08-14-governments-reply-brief-negotiated-charges-appeal-august-14-2020">Government’s Reply Brief In Negotiated Charges Appeal</a> (August 14, 2020) <a> </a> <a href="/amicus-brief/2020-07-24-hospital-associations-amicus-brief-negotiated-charges-appeal-july-24-2020">Hospital Associations Amicus Brief in Negotiated Charges Appeal</a> (July 24, 2020) <a href="/amicus-brief/2020-07-24-us-chamber-amicus-brief-negotiated-charges-appeal-july-24-2020">US Chamber Amicus Brief in Negotiated Charges Appeal</a> (July 24, 2020) <a href="/amicus-brief/2020-07-24-hfma-amicus-brief-negotiated-charges-appeal-july-24-2020">HFMA Amicus Brief in Negotiated Charges Appeal</a> (July 24, 2020) <a href="/legal-documents/2020-07-17-opening-appeals-brief-re-disclosure-negotiated-charges-july-17-2020">Opening Appeals Brief</a> (July 17, 2020) <a href="/legal-documents/2020-07-06-dc-circuits-order-adopting-aha-recommended-expedited-briefing-schedule">D.C. Circuit’s Order Adopting AHA Recommended Expedited Briefing Schedule for Appeal</a> (July 7, 2020) <a href="/legal-documents/2020-07-06-motion-expedite-appeal-july-3-2020">Motion to Expedite Appeal</a>&nbsp;(July 3, 2020) <a href="/legal-documents/2020-06-24-notice-appeal-court-decision-public-disclosure-negotiated-rates-june-23">Notice of Appeal</a> (June 23, 2020) <a href="/legal-documents/2020-06-23-court-decision-disclosure-negotiated-charges-lawsuit-june-23-2020">Court Decision in Disclosure of Negotiated Charges Lawsuit</a> (June 23, 2020) <a href="/legal-documents/2020-04-28-governments-reply-brief-disclosure-negotiated-charges-lawsuit-march-24">Government’s Reply Brief in Disclosure of Negotiated Charges Lawsuit</a> (March 24, 2020) <a href="/system/files/media/file/2020/03/court-sets-april-22-hearing-date-aha-challenge-to-rule-requiring-hospitals-disclose-negotiated-charges-3-5-2020.pdf">Court Sets April 22 Hearing Date in AHA’s Challenge to the Rule Requiring Hospitals to Disclose Negotiated Charges</a> (March 5., 2020) <a href="/system/files/media/file/2020/03/us-chamber-commerce-files-amicus-brief-supporting-legal-challenge-rule-requiring-disclosure-of-negotiated-charges-2-28-2020.pdf">US Chamber of Commerce Files Amicus Brief Supporting Legal Challenge to Rule Requiring Disclosure of Negotiated Charges</a> (Feb. 28. 2020) <a href="/system/files/media/file/2020/03/aha-reply-brief-case-to-prevent-disclosure-negotiated-contracts-2-28-2020.pdf">AHA Reply Brief in Case to Prevent Disclosure of Negotiated Contracts</a> (Feb. 28, 2020) <a href="/legal-documents/2020-02-28-amicus-brief-37-state-hospital-associations-support-plaintiffs-motion">Amicus Brief of the State Hospital Associations in Support of AHA Lawsuit Challenging Disclosure of Negotiated Charges Rule</a> (Feb. 28, 2020) <a href="/system/files/media/file/2020/02/government-moves-for-summary-judgement-in-disclosure-of-negotiated-charges-lawsuit-2-4-2020.pdf">Government Moves for Summary Judgement in Disclosure of Negotiated Charges Lawsuit</a> (Feb. 4, 2020) <a href="/system/files/media/file/2019/12/scheduling-order-signed-by-judge-nichols-12-18-19.pdf">Scheduling Order Signed by Judge Nichols</a> (Dec. 18, 2019) <a href="/system/files/media/file/2019/12/joint-motion-for-scheduling-order-disclosure-of-negotiated-charges-12-13-19-.pdf">Joint Motion for Scheduling Order</a> (December 13, 2019) <a href="/system/files/media/file/2019/12/aha-hospital-group-brief-in-support-of-their-motion-for-summary-judgment-disclosure-of-negotiated-charges-12-9-19.pdf">AHA, Hospital Group Brief in Support of Their Motion for Summary Judgment</a> (Dec. 9, 2019) <a href="/system/files/media/file/2019/12/hospital-groups-lawsuit-over-illegal-rule-mandating-public-disclosure-individually-negotiated-rates-12-4-19.pdf%20.pdf">Hospital Groups File Lawsuit Over Illegal Rule Mandating Public Disclosure of Individually Negotiated Rates</a>, December 4, 2019 </div> </li> <li class="a-items"> Site Neutral Payment Policy <div class="a-content"> <a href="/legal-documents/2021-05-28-aha-reply-government-related-petition-cert-us-supreme-court-site-neutral">AHA Reply to Government Related to Petition for Cert at US Supreme Court (May 28, 2021)</a> <a href="/system/files/media/file/2021/02/amicus-brief-state-regional-hosp-associations-site-neutral-2-23-21.pdf">Amicus Brief-State and Regional Hospital Associations</a> (Feb. 23, 2021) <a href="/legal-documents/2021-02-10-aha-asks-us-supreme-court-hear-case-hospital-outpatient-payment-cuts">AHA Asks U.S. Supreme Court to Hear Case Hospital Outpatient Payment Cuts</a> (Feb. 10, 2021) <a href="/legal-documents/2020-12-11-joint-status-report-court-re-site-neutral-lawsuit-dec-11-2020">Joint Status Report to the Court</a> (Dec. 11, 2020) <a href="/legal-documents/2020-08-31-hospital-groups-petition-rehearing-re-site-neutral-payment-policy-august">Hospital Groups Petition for Rehearing Re: Site Neutral Payment Policy</a> (August 31, 2020) <a href="/system/files/media/file/2020/07/site-neutral-decision-appeals-court-7-17-20.pdf">Decision from the Appeals Court Re: Site Neutral Payment Policy</a> (July 17, 2020) <a href="/system/files/media/file/2020/03/government-reply-in-the-site-neutral-2020-lawsuit-march-12-2020.pdf">Government’s Reply in the Site Neutral 2020 Lawsuit</a> (March 12, 2020) <a href="/system/files/media/file/2020/03/government-reply-in-appeal-of-its-site-neutral-loss-3-11-2020.pdf">Government’s Reply in Appeal of Its Site Neutral Loss</a> (March 11, 2020) <a href="/system/files/media/file/2020/03/aha-responds-governments-opposition-brief-cross-motion-2020-site-neutral-rulemaking-challenge.pdf">AHA Responds to the Government’s Opposition Brief/Cross-Motion in the 2020 Site Neutral Rulemaking Challenge</a> (March 3, 2020) <a href="/system/files/media/file/2020/03/governments-opposition-brief-cross-motion-in-2020-site-neutral-rulemaking-challenge-feb-18-2020.pdf">Government’s Opposition Brief/Cross-Motion in the 2020 Site Neutral Rulemaking Challenge</a> (Feb 18, 2020) <a href="/legal-documents/2020-02-21-appeals-court-urged-reject-cms-argument-outpatient-payment-case">Appeals Court Urged to Reject CMS Argument in Outpatient Payment Case</a> (Feb. 20, 2020) <a href="/legal-documents/2020-02-11-order-court-sets-oral-argument-date-april-17-governments-appeal-its-loss">Court Sets oral Argument Date of April 17 in the Government’s Appeal of Its Loss on Site-Neutral Payment Reduction</a> (Feb. 10, 2020) <a href="/legal-documents/2020-02-03-2020-site-neutral-amended-complaint-feb-2-2020">2020 Site Neutral Amended Complaint</a>&nbsp; (Feb. 2, 2020) <a href="/legal-documents/2020-02-03-2020-site-neutral-summary-judgment-brief-feb-2-2020">2020 Site Neutral Summary Judgment Brief</a> (Feb. 2, 2020) <a href="/system/files/media/file/2020/01/government-initial-brief-in-appeal-of-aha-aamc-hospitals-site-neutral-win-1-23-2020.pdf">Government’s Initial Brief in Their Appeal of AHA, AAMC and Hospitals’ Site Neutral Win</a> (Jan. 23, 2020) <a href="/system/files/media/file/2020/01/Site-neutral-2020-complaint.pdf">Site Neutral 2020 Complaint</a> (Jan. 13, 2020) <a href="/system/files/media/file/2020/01/briefing-schedule-site-neutral.pdf">Briefing schedule in the goverment's appeal of its loss in AHA, AAMC and hospital’s challenge to site neutral payment reduction</a> (Dec. 18, 2019). <a href="/system/files/media/file/2019/12/court-decision-motion-to-enforce-site-neutral-payments-12-16-19.pdf">Court Decision on Motion to Enforce</a> (Dec. 16, 2019) <a href="/system/files/media/file/2019/12/government-notice-appeal-of-site-neutral-court-ruling-that-favored-hospitals.pdf">Government Notice of Its Appeal of Site Neutral Court Ruling that Favored Hospitals</a>&nbsp;(December 12, 2019) <a href="/system/files/media/file/2019/12/cms-will-repay-2019-outpatient-payment-cut-as-result-of-aha-lawsuit-12-12-19.pdf">CMS Will Repay 2019 Outpatient Payment Cut as a Result of AHA Lawsuit</a> (December 12, 2019) <a href="/system/files/media/file/2019/12/supplemental-notice-support-motion-to-enforce-site-neutral-12-9-19.pdf">Supplemental Notice In Support of Motion to Enforce</a> (December 12, 2019) <a href="/system/files/media/file/2019/12/aha-aamc-hospitals-respond-in-support-their-motion-to-enforce-courts-judgment-12-5-19.pdf">AHA, AAMC and Hospitals Respond in Support of Their Motion to Enforce the Court’s Judgment </a>(December&nbsp;5, 2019) <a href="legal-documents/2019-11-25-united-states-governments-response-aha-aamc-and-hospitals-motion-enforce">United States Government’s Response to AHA, AAMC and Hospitals Motion to Enforce Court’s Judgment</a>, November 25, 2019 <a href="/system/files/media/file/2019/11/plaintiffs-motion-to-enforce-judgment-site-neutrasl-11-11-19.pdf">Plaintiffs’ Motion to Enforce Judgment</a>, November 11, 2019 <a href="/system/files/media/file/2019/11/memorandum-in-support-of-plaintiffs-motion-to-enforce-judgment-site-neutal-11-11-19.pdf">Memorandum In Support of Plaintiffs’ Motion to Enforce Judgment</a>, November 11, 2019 <a href="/system/files/media/file/2019/11/minute-order-site-neutral-11-12-19.pdf">Court Sets Briefing Schedule on Our Motion to Enforce the Court's Judgment in the Case (Nov. 12, 2019)</a> <a href="/system/files/media/file/2019/11/government-response-aha-aamc-hospitals-notice-intent-enforce-courts-order-vacating-site-neutral-payment-reduction.pdf">Government’s Response to AHA, AAMC and Hospitals’ Notice of Intent to Enforce Court’s Order Vacating Site Neutral Payment Reduction</a>, November 7, 2019 <a href="/system/files/media/file/2019/11/notice-intent-file-motion-enforce-judgment-request-briefing-schedule-site-neutral-11-7-2019.pdf">Notice of Intent to File Motion to Enforce Judgment and Request for Briefing Schedule</a>, November 6, 2019 <a href="/system/files/media/file/2019/11/proposed-order-setting-briefing-schedule-plaintiffs-motion-enforce-judgment-site-neutral-11-7-19.pdf">Proposed Order Setting the Briefing Schedule For Plaintiffs’ Motion to Enforce Judgment</a>, November 6, 2019 <a href="/system/files/media/file/2019/10/courts-final-order-closing-the-case-site-neutral-litigation-10-21-2019.pdf">Court’s Final Order Closing the Case</a>, October 21, 2019 <a href="/system/files/media/file/2019/10/memorandum-opinion-dckt-38-0-site-neutral-payment-10-21-2019.pdf">Court Will Neither Modify Nor Stay The Order Vacating The Rule’s Provisions</a>, October 21, 2019 <a href="/system/files/media/file/2019/10/site-neutral-government-remedy-reply-19-07-2019.pdf">Government Remedy Reply</a> (October 7, 2019) <a href="/system/files/media/file/2019/10/joint-status-report-site-neutral-10-1-2019.pdf">Joint Status Report</a> (Oct. 1, 2019) <a href="/system/files/media/file/2019/10/aha-aamc-hospitals-opposition-to-governments-motion-to-modify-order-vacating-rules-provision-9-30-2019.pdf">AHA, AAMC, Hospitals Opposition to Government’s Motion to Modify Order Vacating Rule’s Provision</a> (Sept. 30, 2019) <a href="/system/files/media/file/2019/09/government-motion-brief-support-reconsideration-9-23-2019-dckt-33-0.pdf">Government Motion/Brief in Support of Reconsideration</a> (September 23, 2019) <a href="/system/files/media/file/2019/09/government-proposed-motion-for-court-site-neutral-9-23-2019-dckt-33-1.pdf">Government Proposed Order for the Court</a> (September 23, 2019) <a href="/system/files/media/file/2019/09/Site-Neutral-Payment-Policy-Opinion_20190717.pdf">Opinion in the AHA's Case on OPPS Site Neutral Payment Policy</a> (September 17, 2019) <a href="/system/files/media/file/2019/08/aha-aamc-hospitals-response-to-judge-show-cause-order-on-consolidation-8-20-2019.pdf">AHA, AAMC and Hospitals Response to Judge Show Cause Order On Consolidation</a> (August 20, 2019) <a href="/system/files/media/file/2019/08/order-to-show-cause-8-15-2019-site-neutral.pdf">Order to Show Cause</a> (August 15, 2019) <a href="/system/files/media/file/2019/08/aha-hospital-organizations-notice-request-for-status-conference-8-2-2019.pdf">AHA and hospital organizations notice and request for a status conference</a> (August 8, 2019) <a href="/system/files/media/file/2019/04/government-reply-in-support-of-its-motion-april-19-2019-site-neutral_0.pdf">Government's reply in support of its motion</a> (April 19, 2019) <a href="/system/files/media/file/2019/04/AHA-REPLY-to-government-motion-to-dismiss_20190405.pdf">Reply in Support of Plaintiffs’ Motion for Summary Judgment and Memorandum in Opposition to Defendant’s Cross-Motion to Dismiss or for Summary Judgment</a> (April 5, 2019) <a href="/system/files/media/file/2019/03/Site-neutral-defendant-opposition-to-summary-judgment-filed-032219.pdf">Defendant's Opposition to Plaintiff's Motion for Summary Judgment and Memorandum in Support of Motion to Dismiss</a>&nbsp;(March 22, 2019) <a href="/system/files/2019-03/Minute-order-of-Judge-Collyer-establishing-new-consolidated-briefing-schedule-in-site-neutral-lawsuit_20190309.pdf">Minute order of Judge Collyer establishing new consolidated briefing schedule in site neutral lawsuit</a> (March 9, 2019) <a href="/system/files/2019-03/Response-to-the-Courts-Minute-Order-of-February-27-2019_20190306.pdf">Response to the Court’s Minute Order of February 27, 2019</a> (March 6, 2019) <a href="/system/files/2019-02/Courts-minute-order-setting-case-briefing-schedule_digital_20190204.pdf">Court’s minute order setting case briefing schedule</a> (February 4, 2019) <a href="/system/files/2019-02/Plaintiffs-Motion-for-Summary-Judgment-Site-Neutral-Payment-Policy_2019-02-01.pdf">Plaintiffs’ Motion/Brief for Summary Judgment</a> (February 1, 2019) <ul> <li><a href="/system/files/2019-02/Plaintiffs-Declarations-Site-Neutral-Payment-Policy_2019-02-01.pdf">Plaintiffs’ Declarations</a> (February 1, 2019)</li> <li><a href="/system/files/2019-02/Plaintiffs-Declarations-and-Proposed-Order-Site-Neutral-Payment-Policy_2019-02-01.pdf">Plaintiffs’ Declarations and Proposed Order</a> (February 1, 2019)</li> </ul> <a href="/system/files/2019-02/Joint-Motion-for-Briefing-Schedule-Site-Neutral-Payment-Policy_2019-02-01.pdf">Joint Motion for Briefing Schedule</a> (February 1, 2019) <ul> <li><a href="/system/files/2019-02/Joint-Proposed-Order-for-Briefing-Schedule-Site-Neutral-Payment-Policy_2019-02-01.pdf">Joint Proposed Order for Briefing Schedule</a> (February 1, 2019)</li> </ul> <a href="/system/files/2019-01/aha-site-neutral-amended-complaint-1-29-2019_0.pdf">Amended Complaint</a> (January 29, 2019) <a href="/system/files/2018-12/complaint-challenging-site-neutral-payment-policy181204.pdf">Complaint Challenging Site Neutral Payment Policy</a> (December 4, 2018) </div> </li> <li class="a-items"> 340B Payment Reductions <div class="a-content"> <a href="/legal-documents/2022-09-28-judge-orders-hhs-immediately-halt-unlawful-reimbursement-cuts-remainder" target="_blank">Judge Orders HHS to Immediately Halt Unlawful Reimbursement Cuts for Remainder of 2022 </a> (September 28, 2022) <a href="/2022-09-21-amicus-brief-reply-support-plaintiffs-motion-hold-unlawful-and-remedy-defendants-past" target="_blank">Reply in Support of Plaintiffs’ Motion to Hold Unlawful and Remedy Defendants’ Past Underpayment of 340b Drugs</a> (September 21, 2022) <a href="/legal-documents/2022-08-17-ahas-reply-support-plaintiffs-motion-vacate-unlawful-portion-2022-opps" target="_blank">Reply in Support of Plaintiffs’ Motion to Vacate the Unlawful Portion of the 2022 OPPS Rule</a> (August 17, 2022) <a href="/system/files/media/file/2022/08/unopposed-motion-for-permission-to-file-second-supplemantal-complaint-re-340B-payment-reduction-8-3-22.pdf" target="_blank">Unopposed Motion For Permission To File Second Supplemantal Complaint</a> (August 3, 2022) <a href="/system/files/media/file/2022/08/second-supplemental-complaint-re-340b-payment-reduction-8-3-22.pdf" target="_blank">Second Supplemental Complaint</a> (August 3, 2022) <a href="/system/files/media/file/2022/08/motion-to-vacate-the-unlawful-portion-of-the-2022-opps-rule-re-340b-payment-reduction-8-3-22.pdf">Motion to Vacate The Unlawful Portion of the 2022 OPPS Rule</a> (August 3, 2022) <a href="/system/files/media/file/2022/08/motion-to-hold-unlawful-and-remedy-defendants-past-underpayment-of-340b-drugs-8-3-22.pdf" target="_blank">Motion to Hold Unlawful And Remedy Defendants’ Past Underpayment Of 340b Drugs</a> (August 3, 2022) <a href="https://www.supremecourt.gov/opinions/21pdf/20-1114_09m1.pdf" target="_blank">Supreme Court Rules Unanimously in Favor of AHA, Others in 340B Case</a> (June 15, 2022) <a href="/news/blog/2021-11-29-live-analysis-supreme-court-hears-oral-arguments-ahas-340b-case" target="_blank">Live Analysis: Supreme Court Hears Oral Arguments in AHA’s 340B Case</a> (November 30, 2021) <a href="/legal-documents/2021-11-20-aha-associations-hospitals-respond-government-340b-supreme-court-case" target="_blank">AHA, Associations, Hospitals Respond to Government in 340B Supreme Court Case</a> (November 19, 2021) <a href="/legal-documents/2021-10-21-government-responds-hospital-340b-payment-reduction-challenge-oct-20">Government Responds to Hospital 340B Payment Reduction Challenge</a> (October 20, 2021) <a href="/amicus-brief/2021-09-13-amicus-brief-academic-medical-centers-support-aha-340b-case-september-10">Amicus Brief: Academic Medical Centers Support AHA in 340B Case</a> (September 10, 2021) <a href="/amicus-brief/2021-09-13-amicus-brief-state-and-regional-hospital-associations-express-support-ahas">Amicus Brief: State and Regional Hospital Associations Express Support for AHA’s 340B Case</a> (September 9, 2021) <a href="/legal-documents/2021-09-03-aha-opening-brief-case-urging-us-supreme-court-reverse-cut-340b-program">AHA Opening Brief in Case Urging U.S. Supreme Court to Reverse Cut to 340B Program</a> (September 3, 2021) <a href="/legal-documents/2021-05-28-aha-reply-government-related-petition-cert-us-supreme-court-re-340b">AHA Reply to Government Related to Petition for Cert At US Supreme Court</a> (May 28, 2021) <a href="/2021-03-15-amicus-brief-hospital-systems-340b-payment-reductions-march-12-2021">Amicus Brief–Hospital Systems </a> (March 12, 2021) <a href="/amicus-brief/2021-02-23-amicus-brief-state-and-regional-hosp-associations-340b-case">Amicus Brief-State and Regional Hospital Associations</a> (Feb. 23, 2021) <a href="/legal-documents/2021-02-10-aha-asks-us-supreme-court-hear-case-340b-payment-cuts">AHA Asks U.S. Supreme Court to Hear Case on 340B Payment Cuts</a> (Feb. 10, 2020) <a href="/legal-documents/2020-09-14-hospital-groups-petition-rehearing-re-340-b-payment-reductions-sept-14">Hospital Groups Petition for Rehearing</a> (Sept. 14, 2020) <a href="/legal-documents/2020-07-31-appeals-court-decision-july-31-2020-re-340b-payment-reductions-cy-2018">Appeals Court Decision</a> (July 31, 2020) <a href="/system/files/media/file/2019/11/aha-associations-hospitals-response-government-letter-to-dc-circuit-court-re-nov-8-oral-argument-%20340b-payment-reductions-11-14-19.pdf">AHA, Associations, Hospitals response the Government’s Letter to the D.C. Circuit Following Oral Argument in Appeal of The District Court’s Judgment</a> (November 14, 2019) <a href="/legal-documents/2019-11-14-government-letter-following-oral-argument-appeal-district-courts">Government’s Letter to the D.C. Circuit Following Oral Argument in Appeal of the District Court’s Judgment in Favor AHA, Associations, and Hospitals</a> (November 12, 2019) <a href="/system/files/media/file/2019/10/appellants-reply-brief-340b-10-11-2019.pdf">Government's Reply Brief in Its Appeal</a>&nbsp;(October 11, 2019) <a href="/system/files/media/file/2019/09/aha-associations-hospitals-reply-brief-in-government-appeal-340b-9-24-2019.pdf">AHA, Associations, Hospitals Reply Brief in Government Appeal 340B</a> (September 24, 2019) <a href="/system/files/media/file/2019/09/amicus-brief-filed-by-the-federation-of-american-hospitals-9-10-2019.pdf">Amicus Brief Filed by the Federation of ��s (FAH)</a> (September 10, 2019) <a href="/system/files/media/file/2019/09/governments-initial-brief-in-appeal-of-judgement-in-favor-of-aha-associations-hospitals.pdf">Government’s Initial Brief in Their Appeal of the Judgement In Favor of the AHA, Associations and Hospitals</a> (Sept. 3, 2019) <a href="/system/files/media/file/2019/07/order-grants-consolidation-of-cases-to-expedite-340b-doc-1799771-7-30-2019.pdf">Court Grants the Motion to Expedite the Appeal in 340B</a> (July 30, 2019) <a href="/system/files/media/file/2019/07/azar-vs-aha-appellees-consent-motion-to-expedite-7-24-2019.pdf">Appellees’ Consent Motion to Expedite Briefing</a> (July 24, 2019) <a href="/system/files/media/file/2019/07/2019-07-10-Memorandum-Opinion-340B.pdf">Memorandum Opinion Granting Defendants' Motion for Entry of Final Judgement</a>, (July 10, 2019) <ul> <li><a href="/system/files/media/file/2019/07/2019-07-10-Order-Granting-Motion-for-Entry-of-Final-Judgement-Denying-as-Moot.pdf">Order Granting Defendants' Motion for Entry of Final Judgment,</a> (July 10, 2019)</li> </ul> <a href="/system/files/media/file/2019/06/2019-06-10-ecf-57-defendants-reply-in-support-of-motion-for-reconsider.pdf">Defendant's reply in Support of Motion for Reconsideration and Entry of Final Judgmen</a>t&nbsp;(June 10, 2019) <a href="/system/files/media/file/2019/06/2019-06-07-ecf-056-plaintiffs-response-to-defendants-motion-for-reconsideration-340B-payment-reduction.pdf">Plaintiffs’ Response to Defendants’ Motion for Reconsideration, Entry of Final Judgment, and Expedited Briefing</a> (June 7, 2019) <a href="/system/files/media/file/2019/06/plaintiffs-reply-in-support-of-motion-for-a-firm-date.pdf">Plaintiffs’ Reply In Support of Motion for a Firm Date</a> (June 4, 2019) <a href="/system/files/media/file/2019/06/2019-05-31-efc-053-defendants-opposition-to-plaintiffs-motion-for-firm-date.pdf">Government’s Reply to Plaintiff's Motion to Expedite a Remedy</a> (May 31, 2019) <a href="/system/files/media/file/2019/05/2019-05-10-ECF-051-defendants_motion-firm-date-by-which-defendants-must-propose-remedy-for-violations-medicare-act.pdf">Plaintiffs’ Motion for a Firm Date by Which Defendants Must Propose a Remedy for Violations of the Medicare Act</a> (May 10, 2019) <ul> <li><a href="/system/files/media/file/2019/05/2019-05-10-ECF-051-01-text-proposed-order.pdf">Proposed Order</a> (May 10, 2019)</li> </ul> <a href="/system/files/media/file/2019/05/2019-05-06-ECF-050-memorandum-opinion-granting-part-motion-permanent-injunction-remanding-2018-2019-opps-rules-to-hhs.pdf">Memorandum Opinion Granting in Part Plaintiffs’ Motion for a Permanent Injunction; Remanding the 2018 and 2019 OPPS Rules to HHS</a> (May 6, 2019) <a href="/system/files/2019-02/2019-02-26_Reply-ISO-Mot-for-Perm-Inj-and-Oppn-to-MTD_as-filed.pdf">Opposition to Government’s Motion to Dismiss and Reply in Support of Motion for a Permanent Injunction Covering the 2019 OPPS Rule</a> (February 26, 2019) <a href="/system/files/2019-02/2019-02-22_ECF-043_Memorandum-in-Support-of-Motion-to-Dismiss-New-Claim-and-Opposition-to-Motion-for-PI-with-Respect-to-2019-OPPS-Rule.PDF">Memorandum in Support of Motion to Dismiss New Claim and Opposition to Motion for Permanent Injunctions with Respect to 2019 OPPS Rule</a> (February 22, 2019) <a href="/system/files/2019-02/2019-02-11_ECF-035_Plaintiffs_Motion-for-a-Permanent-Injunction-Cover-2019-OPPS-Rule.pdf">AHA, Associations, Hospitals’ motion for an injunction for 2019</a> (February 11, 2019) <a href="/system/files/2019-02/ECF-37--Plaintiffs-Response-Brief-on-Remedies.pdf">AHA, Associations, Hospitals Remedies Reply Brief</a> (February 14, 2019) <a href="/system/files/2019-02/2019-02-14_ECF-036_Defendants-Opposition-on-Remedy.PDF">Government’s Remedies Reply Brief</a>&nbsp;(February 14, 2019) <a href="/system/files/2019-02/2019-02-07_ECF-034_Plaintiffs_Motion-for-Leave-to-File-Supplemental-Complaint.PDF">AHA, Associations, Hospitals Motion for Leave to File Supplemental Complaint</a> (February 7, 2019) <ul> <li><a href="/system/files/2019-02/2019-02-07_ECF-034-03_Ex-C--Proposed-Supplemental-Complaint.PDF">Proposed Supplemental Complaint</a> (February 7, 2019)</li> <li><a href="/system/files/2019-02/2019-02-07_ECF-034-04_Ex-D--Redline-with-Original-Complaint.PDF">Redline of Proposed Supplemental Complaint</a> (February 7, 2019)</li> <li><a href="/system/files/2019-02/2019-02-07_ECF-034-05_Text_Proposed-Order.PDF">Proposed Order to Grant Motion</a> (February 7, 2019)</li> </ul> <a href="/system/files/2019-02/2019-02-07_ECF-033_FAH_s-Motion-for-Leave-to-File-Amicus-Brief.PDF">Federation of ��s’ Motion for Leave to file Amicus in support of neither party</a> (February 7, 2019) <ul> <li><a href="/system/files/2019-02/2019-02-07_ECF-033-01_Ex-A--FAH-Amicus-Brief.PDF">FAH Proposed Amicus Brief</a> (February 7, 2019)</li> </ul> <a href="/system/files/2019-02/2019-01-31-Plaintiffs-Brief-on-Remedies-as-filed.pdf">AHA, Associations, Hospitals Remedies Brief</a> (January 31, 2019) <a href="/system/files/2019-02/2019-01-31-ECF-031-Defendant_s-Brief-on-Remedy.PDF">Govt. Remedies Brief</a> (January 31, 2019) <ul> <li><a href="/system/files/2019-02/2019-01-31-ECF-031-01-Declaration-of-Elizabeth-Richter.PDF">Declaration of CMS’s Elizabeth Richter</a> (January 31, 2019)</li> </ul> <a href="/system/files/2019-01/2019-01-07-ECF-027-Plaintiffs-Opposition-to-Motion-to-Stay.pdf">AHA, Associations, Hospitals Opposition to Request to Stay Proceedings</a> (January. 7, 2019) <ul> <li> <ul> <li><a href="/system/files/2019-02/Joint-Proposed-Order-for-Briefing-Schedule-Site-Neutral-Payment-Policy_2019-02-01.pdf">Joint Proposed Order for Briefing Schedule</a> (February 1, 2019)</li> </ul> <ul> </ul> <ul> <li><a href="/system/files/2018-12/0029-2018-12-20-notice-of-Filing-amended-complaint.pdf">Notice of amending complaint filing</a> (December. 20, 2018)</li> </ul> <ul> <li><a href="/system/files/2018-11/181121-340b-delay-proposed-order.pdf">Proposed Order</a></li> <li><a href="/system/files/2018-11/181121-340b-delay-exhibits.pdf">Exhibits</a></li> </ul> <ul> <li><a href="/system/files/2018-10/181015-proposed-order-motion-to-stay-340b.pdf">Proposed Order</a></li> </ul> <ul> <li><a href="/system/files/2018-09/180911-340b-delay-suit-complaint.pdf">Complaint</a></li> <li><a href="/system/files/2018-09/180911-plaintiffs-motion-for-summary-judgement.pdf">Motion for Summary Judgment</a></li> <li><a href="/system/files/2018-09/180911-memo-points-authorities-plaintiffs-motion.pdf">Memorandum in Support of Motion</a></li> </ul> <ul> <li><a href="/system/files/2019-01/2019-01-07-ECF-027-02-Ex-B-Order-in-Maryland-v-US-1-03-2019.pdf">Order in Maryland v. US</a></li> <li><a href="/system/files/2019-01/2019-01-09-ECF-028-Plaintiffs-Notice-of-Supplemental-Authority.pdf">Plaintiffs’ Notice of Supplemental Authority</a> (January&nbsp;9, 2019)</li> <li><a href="/system/files/2019-01/2019-01-09-ECF-028-01-USCA-Order-of-01-09-2018.pdf">Supplemental Authority Cited - Court of Appeals Jan. 9 Order denying Stay on basis of Appropriations Lapse</a></li> </ul> </li> <li><a href="/system/files/2019-01/2019-01-06-ECF-026-Defendants-Motion-for-Stay-in-Light-of-Lapse-in-Appropriations.pdf">Govt. Motion to Stay Case Proceedings in Light of Appropriations Lapse</a> (January 6, 2019) <div class="body"> <a href="/system/files/2018-12/Opinion%20%20on%20340B%20Injunction%2012.27.18.pdf">Court opinion</a> (December 27, 2018) <ul> <li><a href="/system/files/2018-12/Order-on-340B-Injunction-12-27-18.pdf">Associated order of the Court</a> (December 27, 2018)</li> </ul> <a href="/system/files/2018-12/181203-notice-of-alj-rulings.pdf">Notice of ALJ Rulings</a> (December 3, 2018) <a href="/system/files/2018-10/181010-govt-reply-340b.pdf">Government's reply brief in support of their motion to dismiss</a> (October 10, 2018) <a href="/system/files/2018-10/180926-reply-motion-for-permanent-injunction.pdf">Plaintiffs' reply brief in in support of motion for preliminary and permanent injunction and opposition to government’s motion to dismiss</a> (September 26, 2018) <a href="/system/files/2018-09/180914-340b-govt-motion-to-dismiss.pdf">Government's Motion to Dismiss</a> (September 14, 2018) <ul> <li><a href="/system/files/2018-09/180914-340b-govt-memo-in-support-motion-dismiss.pdf">Memorandum in Support of Defendants' Motion to Dismiss</a></li> <li><a href="/system/files/2018-09/180914-340b-proposed-order.pdf">Proposed Order</a></li> <li><a href="/system/files/2018-09/180914-340b-exhibit1-2016-cms-stats.pdf">Exhibit 1: 2016 CMS Statistics</a></li> <li><a href="/system/files/2018-09/180914-340b-exhibit2-htc-manual.pdf">Exhibit 2: Hemophilia Treatment Center Manual </a></li> </ul> <a href="/legal-documents/2018-09-05-hospital-groups-refile-lawsuit-reverse-cuts-340b-hospitals">Hospital Groups Refile Lawsuit to Reverse Cuts for 340B Hospitals</a> (September 5, 2018) <ul> <li><a href="/system/files/2018-09/180905-complaint-340b-refiling-suit.pdf">Complaint</a></li> <li><a href="/system/files/2018-09/180905-brief-340b-refiling-suit.pdf">Brief</a></li> </ul> <a href="/system/files/2018-07/180717-340b-suit-dismissal.pdf">Appeals court dismisses 340B payment lawsuit for lack of presentment</a> (July 17, 2018) <a href="/legal-documents/2018-06-14-letter-us-court-appeals-dc-circuit-providing-mac-notices-exhibits-re">Letter to Court of Appeals for the D.C. Circuit providing MAC notices</a> (June 14, 2018) <a href="/system/files/2018-05/20180510-letter-hhs-28j.pdf">Government's 28(j) Letter</a> (May 10, 2018) <ul> <li><a href="/system/files/2018-05/20180511-letter-responding-to-28j.pdf">AHA Response to the Government's 28(j) Letter</a> (May 11, 2018)</li> </ul> </div> <a href="/2018-04-02-aha-reply-brief-340b-appeal">AHA Reply Brief Calls for Preliminary Injunction</a> (April 2, 2018) <a href="/legal-documents/2018-03-20-governments-brief-march-19-2018">Government's Brief</a> (March 19, 2018) <a href="/amicus-brief/2018-02-22-aha-hospital-associations-amicus-brief-340b-appeal-feb-22-2018">Hospital Associations Amicus Brief in 340B Appeal</a> (February 22, 2018) <a href="/legal-documents/2018-02-15-ahas-appeal-brief-re-340b-payment-reductions-included-opps-rule ">AHA's Appeal Brief re 340B Payment Reductions</a> (February 15, 2018) <a href="/system/files/2018-02/180130-courts-grants-expedite-340b.pdf">340B Appeal: Court grants Associations, Hospitals Motion to Expedite</a> (January 30, 2018) <a href="/system/files/2018-02/180122-reply-in-support-motion-expedite-340b.pdf">340B Motion to Expedite: Associations, Hospitals Reply</a> (January 22, 2018) <a href="/system/files/2018-02/180119-motion-to-expedite-340b.pdf">340B Motion to Expedite: HHS Response</a> (January 19, 2018) <a href="/system/files/2018-02/180117-motion-to-expedite-340b.pdf">340B Litigation – Associations, Hospitals Motion to Expedite Appeal </a>(January 17, 2018) <a href="/legal-documents/2018-01-09-aha-aamc-aeh-hospitals-notice-appeal">AHA, AAMC, AEH, Hospitals, Notice of Appeal</a> (January 9, 2018) Court Decision in 340b Case (December 29, 2017) <ul> <li><a href="/legal-documents/2017-12-29-aha-v-eric-d-hargan-order-granting-motion-dismiss" target="_blank">Court Order Granting Govt. Motion to Dismiss</a></li> <li><a href="/system/files/content/17/171229-ecf-024-memorandum-opinion-garnting-motion-to-dismiss-denying-as-moot-motion-for-preliminary-injunction.pdf" target="_blank">Court Memorandum Opinion Granting Govt. Motion to Dismiss</a></li> </ul> <a href="/system/files/content/17/171215-340b-payment-reductions-in-2018-final-opps-rule.pdf" target="_blank">Government’s reply brief</a> (December 15, 2017) <a href="/system/files/content/17/171208-amicus-brief-associations-340b.pdf">Hospital Associations Amicus Brief Supporting 340B lawsuit</a> (December 8, 2017) <a href="/system/files/content/17/171208-ahareplyisomotionforpreliminjunction.pdf">AHA, AAMC, AEH, Hospitals reply to Govt's Motion to Dismiss 340B lawsuit</a> (December 8, 2017) <a href="/system/files/content/17/171201-govt-brief-motion-to-dismiss.pdf">Department of Health and Human Services' Motion to Dismiss</a> (December 1, 2017) <ul> <li><a href="/system/files/content/17/171201-memo-support-motion-to-dismiss.pdf">Memorandum in Support of Government Motion to Dismiss and in Opposition to Plaintiffs' Motion for Preliminary Injunction</a></li> </ul> <a href="/system/files/content/17/171113-complaint-340b-final-opps-rule.pdf">Complaint: AHA, Hospital groups v. Department of Health and Human Services</a> (November 13, 2017) <a name="appeals"></a> <ul> <li><a href="/system/files/content/17/171113-motion-for-pi-340b.pdf">Motion for Preliminary Injunction</a></li> <li><a href="/system/files/content/17/171113-motion-iso-pi-340b.pdf">Memo in Support of Motion for Preliminary Injunction (with attachments)</a></li> </ul> </li> </ul> </div> </li> <li class="a-items"> AHA, Hospitals Sue to Require HHS to Meet Deadlines for Deciding Appeals <div class="a-content"> <a href="/legal-documents/2023-04-10-alj-delay-april-2023-status-report-filed-april-7-2023">ALJ Delay April 2023 Filing </a>, April 7, 2023 <a href="/amicus-brief/2022-09-23-plaintiffs-opposition-defendants-motion-modify-courts-mandamus-order-re">Plaintiffs’ Opposition to Defendant’s Motion to Modify This Court’s Mandamus Order Re Medicare Appeals</a>, September 23, 2022 <a href="/legal-documents/2022-03-30-aha-v-becerra-march-2022-status-report">AHA v Becerra Medicare Appeals Status Report and Dashboard</a>, March 30, 2022 <a href="/legal-documents/2021-09-28-alj-delay-case-status-report-and-dashboard-sept-28-2021">ALJ Delay Status Report and Dashboard</a>, September 28, 2021 <a href="/2021-06-25-alj-delay-case-status-report-and-dashboard-june-25-2021">ALJ Delay Status Report and Dashboard</a>, June 25, 2021 <a href="/legal-documents/2021-03-26-alj-delay-status-report-and-dashboard-re-aha-hospitals-sue-require-hhs">ALJ Delay Status Report and Dashboard</a>, March 26, 2021 <a href="/legal-documents/2020-09-24-alj-delay-status-report-and-dashboard-re-aha-hospitals-sue-require-hhs">ALJ Delay Status Report and Dashboard</a>, September 24, 20200 <a href="/legal-documents/2020-06-26-alj-delay-status-report-june-26-2020">ALJ Delay Status Report and Dashboard</a>, June 26, 2020 <a href="/legal-documents/2020-03-28-hhss-march-25-2020-status-report-and-medicare-appeals-dash-board-march">HHS’s March 25 Status Report and Medicare Appeals Dash Board</a> (March 25, 2020) <a href="/legal-documents/2019-12-31-hhss-december-31-status-report-and-medicare-appeals-dashboard-december">HHS's December 31 Status Report and Medicare Appeals DashBoard</a>&nbsp;(December 31, 2019) <a href="/system/files/media/file/2019/09/aha-v-price-september-medicare-appeals-dashboard-9-27-2019.pdf">Medicare Appeals Dashboard</a>&nbsp;(September 27, 2019) <a href="/system/files/media/file/2019/09/aha-v-price-september-status-report.pdf">Status Report</a>&nbsp;(September 27, 2019) <a href="/system/files/media/file/2019/07/aha-vs-azar-july-status-report.pdf">HHS July Status Report</a> (July 1, 2019) <ul> <li><a href="/system/files/media/file/2019/07/aha-vs-azar-july-status-report-dashboard.pdf">HHS July Status Report Dashboard</a></li> </ul> <a href="/news/headline/2018-11-01-court-rules-aha-medicare-appeals-backlog-case">Court rules for AHA in Medicare appeals backlog case</a> (Nov. 1, 2018) <ul> <li><a href="/system/files/2018-11/181101-aljdelay-remedyopinion.pdf">Remedial Opinion</a></li> <li><a href="/system/files/2018-11/181101-aljdelay-remedyorder.pdf">Remedy Order</a></li> </ul> <a href="/system/files/2018-08/AHA-v-Azar-Plaintiffs-Remedies-Reply-With-ECF-Stamp.pdf">AHA, Hospitals reply to Government’s response to recommended non-deadline remedies</a> (Aug. 10, 2018) <a href="/legal-documents/2018-08-06-secretarys-remedy-response-brief">Government's Response to the Remedies Response</a> (Aug. 3, 2018) <ul> <li><a href="/system/files/2018-08/180803-ahavazar-secy-remedy-brief.pdf">Secretary's Remedy Brief</a></li> <li><a href="/system/files/2018-08/180803-ahavazar-griswold-remedy-declaration.pdf">Griswold Remedy Declaration</a> <ul> <li><a href="/system/files/2018-08/180803-ahavazar-griswold-remedy-declaration-exh-a.pdf">Griswold Remedy Declaration Exhibit A</a></li> <li><a href="/system/files/2018-08/180803-ahavazar-griswold-remedy-declaration-exh-b.pdf">Griswold Remedy Declaration Exhibit B</a></li> </ul> </li> <li><a href="/system/files/2018-08/180803-ahavazar-mills-remedy-declaration.pdf">Mills Remedy Declaration</a></li> <li><a href="/system/files/2018-08/180803-ahavazar-mcqueen-remedy-declaration.pdf">McQueen Remedy Declaration</a></li> <li><a href="/system/files/2018-08/180803-ahavazar-cochran-remedy-declaration.pdf">Cochran Remedy Declaration</a></li> <li><a href="/system/files/2018-08/180803-ahavazar-iwugo-remedy-declaration.pdf">Iwugo Remedy Declaration</a></li> </ul> <a href="/system/files/2018-07/180719-alj-delay-courts-grants-ext.pdf">The Court grants govt until Aug 3 to respond to AHA, Hospitals remedies brief</a> (July 19, 2018) <a href="/system/files/2018-07/180711-notice-electronic-filing-extension-request.pdf">Government does not get anywhere as much time for its reply as they requested</a> (July 11, 2018)&nbsp; <a href="/system/files/2018-07/180702-hospitals-oppose-sec-motion-for-extension.pdf">AHA, Hospitals Oppose the Secretary Motion for Extension of Time to Reply</a> (July 5, 2018) <ul> <li><a href="/system/files/2018-07/180702-govt-extension-motion.pdf">Government's motion for extension</a></li> </ul> <a href="/system/files/2018-06/180622-aha-azar-plaintiff-opening-brief.pdf">AHA, Hospitals brief outlining non-deadline remedies to address appeals backlog</a> (June 22, 2018) <ul> <li><a href="/system/files/2018-06/180622-aha-azar-plaintiffs-remedy-proposed-order.pdf">Proposed Remedial Order</a></li> </ul> <a href="/legal-documents/2018-03-22-court-order-alj-delay-case-march-22-2018">Court Order</a> (March 22, 2018) <a href="/system/files/media/file/2019/08/aha-v-azar-340b-response-to-plaintiffs-notice-of-supplemental-authority-3-21-18.pdf">Response to Plaintiffs Notice of Supplemental Authority</a> (March 21, 2018) <a href="/system/files/media/file/2019/08/aha-v-azar-declaration-michael-r-bagel-3-21-2018.pdf">Declaration of Michael R. Bagel</a> (March 21, 2018) <a href="/system/files/2018-03/180227-court-date-alj-delay.pdf">Court Sets Hearing Date for ALJ Delay Mandamus Remand</a> (February 27, 2018) <a href="/legal-documents/2018-02-15-reply-brief-aha-hospitals-alj-backlog-mandamus-order">AHA's and Hospitals' Reply Brief: Reinstate HHS Deadline to Clear Appeals Backlog</a> (February 15, 2018) <a href="/system/files/2018-02/AHAvAzar-SecyOpptoMSJ.pdf">Government’s Brief in Support of its Motion for Summary Judgment/in Opposition to AHA, Hospitals’ Motion for Summary Judgment</a> (February 1, 2018) <ul> <li><a href="/system/files/2018-02/AHAvAzar-GriswoldSuppDecl.pdf">Nancy Griswold's Supporting Declaration</a></li> <li><a href="/system/files/2018-02/AHAvAzar-SecyUpdatedWorkloadProjections.pdf">Medicare Appeals Updated Workload Projections</a></li> </ul> <a href="/system/files/content/17/aha-vs-hargan.pdf" target="_blank">AHA's and Hospitals' Reply Brief on Mandamus Remand</a> (December 20, 2017) <a href="/system/files/2018-02/171122-AHAvHargan-MillsProgramIntegrityDeclaration.pdf">Declaration of George Mills, Deputy Director of the Center for Program Integrity (CPI), CMS</a> (November 22, 2017) <a href="/system/files/2018-02/171103-AHAvHargan-MSJ.pdf">Government's Motion for Summary Judgment in the ALJ Mandamus Remand</a> (November 3, 2017) <ul> <li><a href="/system/files/2018-02/171103-AHAvHargan-MSJBagelDecl.pdf">Declaration of Michael R. Bagel</a></li> <li><a href="/system/files/2018-02/171103-AHAvHargan-MSJGriswoldDecl.pdf">Declaration of Nancy J. Griswold</a></li> <li><a href="/system/files/2018-02/171103-AHAvHargan-MSJMcQueenDecl.pdf">Declaration of Sherri McQueen</a></li> <li><a href="/system/files/2018-02/171103-AHAvHargan-MSJMillsDecl.pdf">Declaration of George G. Mills</a></li> <li><a href="/system/files/2018-02/171103-AHAvHargan-MSJMemoofLaw.pdf">Memorandum of Points and Authorities in Support of Defendant's Motion for Summary Judgment</a></li> <li><a href="/system/files/2018-02/171103-AHAvHargan-MSJStatementofFacts.pdf">Defendant's Statement of Facts</a></li> </ul> <a href="/system/files/2018-03/171025-extension-granted.pdf">Court Grants In Part Govt’s Request for Additional Time</a> (October 25, 2017) <a href="/system/files/2018-02/171023-AHAvHargan-PartialExtOpp.pdf">AHA, Hospitals Oppose Request of Govt. for Additional Time to File</a> (October 23, 2017) <a href="/system/files/2018-02/AHAvPrice-HHSExtensionMotion.pdf">Government Requests Extension of Time to File Its Motion for Summary Judgment </a>(October 19, 2017) <a href="/system/files/2018-02/170928-AHAvPrice-OrderGoverningFurtherProceedings.pdf">Trial Court Sets Briefing Schedule in ALJ Mandamus Remand</a> (September 28, 2017) <a href="/system/files/2018-03/170914-court-order-granting-motion-for-immediate-issuance.pdf">Appeals Court grants AHA, Hospitals Request for Immediate Issuance of Mandate of Remand</a> (September 14, 2017) <ul> <li><a href="/system/files/2018-03/170914-issuance-of-mandate-immediate-remand-to-trial-court.pdf">Issuance of the Mandate of Immediate Remand to the Trial Court</a></li> </ul> <a href="/system/files/2018-02/AHAvPrice-MandateMotion.pdf">AHA, Hospitals Unopposed Motion to Issue Mandate for Case Remand Without Delay</a> (September 11, 2017) <a href="/legal/litigation-aha-hospitals-sue-require-hhs-meet-deadlines-deciding-appeals">Read more on this topic</a> </div> </li> </ul> </li> </ul> </li> </ul> </div> &nbsp; <ul class="a-container"> <ul class="a-container"> item 1 <div class="a-content"> ==== </div> </li> </ul> <div> --&gt; function openCity(evt, cityName) { var i, tabcontent, tablinks; tabcontent = document.getElementsByClassName("tabcontent"); for (i = 0; i &lt; tabcontent.length; i++) { tabcontent[i].style.display = "none"; } tablinks = document.getElementsByClassName("tablinks"); for (i = 0; i &lt; tablinks.length; i++) { tablinks[i].className = tablinks[i].className.replace(" active", ""); } document.getElementById(cityName).style.display = "block"; evt.currentTarget.className += " active"; } // Get the element with id="defaultOpen" and click on it document.getElementById("defaultOpen").click(); </ul> </div> <table border="0" cellpadding="6" class="table" width="80%"> <tbody> <tr> <td align="center" valign="top"> <a class="btn btn-primary btn-wide" href="/legal/past-litigation">PAST LITIGATION</a> </td> <td align="center" valign="top"> <a class="btn btn-primary btn-wide" href="/amicus-briefs">AMICUS BRIEFS</a> </td> </tr> </tbody> </table> </div> /* reset */ .cc_tabs ul.a-container { margin: 0; padding: 0; list-style: none; } .cc_tabs input[type=checkbox] { display: none; } /* style */ .cc_tabs .a-container { width: 100%; margin: 20px auto; } .cc_tabs .a-container label { display: block; position: relative; cursor: pointer; font-size: 18px; font-weight: bold; padding: 10px 20px; color: #63666a; background-color: #eee; border-bottom: 1px solid #ddd; -webkit-transition: all .2s ease; -moz-transition: all .2s ease; -ms-transition: all .2s ease; -o-transition: all .2s ease; transition: all .2s ease; margin-bottom:15px } .cc_tabs .a-container label:after { content: ""; width: 0; height: 0; border-top: 8px solid #aaa; border-right: 6px solid transparent; border-bottom: 8px solid transparent; border-left: 6px solid transparent; position: absolute; right: 10px; top: 16px; } .cc_tabs .a-container input:checked + label, .cc_tabs .a-container label:hover { background-color: #003087; color: #fff; } .cc_tabs .a-container input:checked + label:after { border-top: 8px solid transparent; border-right: 6px solid transparent; border-bottom: 8px solid #fff; border-left: 6px solid transparent; top: 6px; } .cc_tabs .a-content { padding: 0 20px 20px; display: none; height:auto; max-height: 40vh; overflow: auto } .cc_tabs .a-container input:checked ~ .a-content { display: block; } /* Style the tab */ .cc_tabs .tab { background-color: #fff; width: auto; height: auto; overflow: auto; } /* Style the buttons inside the tab */ .cc_tabs .tab button { display: block; background-color: lightgry; color: #003087; padding: 10px 16px 10px 20px; width: calc(50% - 30px); border: solid 1px lightgray; outline: none; text-align: center; cursor: pointer; transition: 0.3s; font-size: 20px; float: left; overflow: auto; margin: 0px 15px; -webkit-border-top-left-radius: 15px; -webkit-border-top-right-radius: 15px; -moz-border-radius-topleft: 15px; -moz-border-radius-topright: 15px; border-top-left-radius: 15px; border-top-right-radius: 15px; font-weight: 700; } @media (max-width:452px){ .cc_tabs .tab button{ padding: 10px 5px 10px 5px; width: calc(50% - 4px); font-size: 17px; margin: 0px 2px; } } /* Change background color of buttons on hover */ .cc_tabs .tab button:hover { background-color: #003087; color:#fff } /* Create an active/current "tab button" class */ .cc_tabs .tab button.active { background-color: #003087; color: #ffffff } /* Style the tab content */ .cc_tabs .tab .tabcontent { float: left; padding: 15px 12px; border: 1px solid #ccc; width: 100%; height: auto; } .cc_tabs .tablinks:after { content: '\2610'; color: #777; font-weight: bold; float: right; margin-left: 5px; } .cc_tabs .tablinks.active:after { content: "\2611"; } Wed, 28 Sep 2022 15:09:22 -0500 Recovery Audit Contractor (RAC) AHA to CMS Regarding Suspension of Medical Review Activities /lettercomment/2020-07-29-aha-cms-regarding-suspension-medical-review-activities AHA urges the Centers for Medicare &amp; Medicaid Services to continue its suspension of medical review activities throughout the ongoing COVID-19 public health emergency. Wed, 29 Jul 2020 13:06:05 -0500 Recovery Audit Contractor (RAC) CMS highlights actions to reduce RAC-related complaints, appeals /news/headline/2019-05-02-cms-highlights-actions-reduce-rac-related-complaints-appeals In a <a href="https://www.cms.gov/blog/recovery-audits-improvements-protect-taxpayer-dollars-and-put-patients-over-paperwork">blog post</a>&nbsp;today, Centers for Medicare &amp; Medicaid Services Administrator Seema Verma highlights recent progress in reducing provider complaints related to the Medicare Recovery Audit Contractor program and associated backlog of appeals, including those generated by RACs, at the Administrative Law Judge level. Last November, a federal court <a href="/news/headline/2018-11-01-court-rules-aha-medicare-appeals-backlog-case">ruled</a>&nbsp;in favor of the AHA and reinstated a mandamus order establishing annual deadline-based targets for reducing the backlog of Medicare appeals at the ALJ level. The order by U.S. District Judge James Boasberg required the Department of Health and Human Services to achieve the following reductions from its own projected fiscal year 2018 backlog of 426,594 appeals: a 19 percent reduction by the end of FY 2019; a 49 percent reduction by the end of FY 2020; a 75 percent reduction by the end of FY 2021; and elimination of the backlog by the end of FY 2022. HHS did not appeal the judge's ruling in the case. Thu, 02 May 2019 15:03:44 -0500 Recovery Audit Contractor (RAC) CMS approves limited Utah Medicaid expansion with work requirement /news/headline/2019-04-01-cms-approves-limited-utah-medicaid-expansion-work-requirement The Centers for Medicare &amp; Medicaid Services Friday approved a Section 1115 <a href="https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ut/ut-primary-care-network-ca.pdf">waiver</a>&nbsp;allowing Utah to amend its Primary Care Network demonstration to provide Medicaid coverage to adults under age 65 with incomes up to 100 percent of the federal poverty level, and require certain adults in the program to register to apply for work to remain eligible. That’s less than the 138 percent FPL required to receive enhanced federal matching funds under the Affordable Care Act. Among other changes, the waiver would require beneficiaries with access to a qualified employer-sponsored plan to enroll in such a plan, close enrollment if projected costs exceed annual state appropriations, and allow the state to provide clinically managed residential withdrawal services to certain adults with substance use disorders. A federal judge last week <a href="/news/headline/2019-03-28-judge-blocks-medicaid-work-requirements-kentucky-and-arkansas">blocked</a>&nbsp;Medicaid work requirements in Kentucky and Arkansas. &nbsp; Mon, 01 Apr 2019 14:56:53 -0500 Recovery Audit Contractor (RAC) ALJ Delay Lawsuit: Remedy Opinion and Order /legal-documents/2018-11-01-alj-delay-lawsuit-remedy-opinion-and-order <h4><a href="/system/files/2018-11/181101-aljdelay-remedyopinion.pdf">Memorandum Opinion</a></h4> This case is now before the Court for a third time, following a second remand from the D.C. Circuit. Plaintiffs here are the �� Association and three other regional hospitals and health-care systems. Fed up by the delays in the administrative-appeals process for Medicare-reimbursement claims, they filed this suit in May 2014. Plaintiffs sought mandamus to compel the Secretary of the Department of Health and Human Services to comply with the statutory deadlines the Medicare Act imposes on the appeals process. See ECF No. 1 (Complaint). The Circuit initially instructed this Court to weigh the equities to determine whether mandamus should issue. After it did so and concluded that the writ was appropriate, the Circuit reversed and remanded the matter for this Court to make a threshold determination of whether it was possible for the Government to comply with the mandamus order. See Am. Hosp. Ass’n v. Price (AHA V), 867 F.3d 160, 161 n.1 (D.C. Cir. 2017). As this time around the Government agrees that recent funding has made compliance possible within four years, the Court will impose such a deadline. <h4><a href="/system/files/2018-11/181101-aljdelay-remedyorder.pdf">Order</a></h4> For the reasons set forth in the accompanying Memorandum Opinion, the Court ORDERS that: 1. Defendant’s Motion for Summary Judgment is DENIED; 2. Plaintiffs’ Cross-Motion for Summary Judgment is GRANTED; 3. Defendant must achieve the following reductions from the currently projected FY 2018 backlog of 426,594 appeals: a 19% reduction by the end of FY 2019; a 49% reduction by the end of FY 2020; a 75% reduction by the end of FY 2021; and elimination of the backlog by the end of FY 2022; and 4. Defendant must file status reports beginning on December 31, 2018, and continuing every quarter thereafter. IT IS SO ORDERED. Thu, 01 Nov 2018 12:06:36 -0500 Recovery Audit Contractor (RAC) Litigation: AHA, Hospitals Sue to Require HHS to Meet Deadlines for Deciding Appeals /legal/litigation-aha-hospitals-sue-require-hhs-meet-deadlines-deciding-appeals <hr /> <a href="/system/files/content/17/170811-cadc-opinion-alj-delay.pdf">Appeals court sends order to eliminate backlog of Medicare appeals back to trial court</a> (August 11, 2017) <a href="/system/files/2018-02/170406govtreply-aljdelay.pdf">Government's reply brief in the ALJ Delay Mandamus Appeal</a> (April 6, 2017) <a href="/system/files/2018-02/170323-appelleebrief-aljdelay.pdf">AHA, Hospitals Reply Brief</a> (and <a href="/system/files/2018-02/170323-stataddendum-aljdelay.pdf">Statutory Addendum</a>) in the Government’s appeal of the ALJ Delay mandamus order (March 23, 2017) <a href="/system/files/2018-02/170221govtopeningbrief.pdf">Government's brief</a> and <a href="/system/files/2018-02/170221jointappendix.pdf">Joint Appendix</a> in their appeal of the ALJ delay mandamus order (February 21, 2017) <a href="/system/files/content/17/170104aljdelayreconsdenied.pdf">Court rejects government's request to reconsider court order compelling HHS to reduce the appeals backlog</a> (January 4, 2017) <a href="/content/16/161221aljdelayoppreconsid.pdf">Opposition to government's motion for reconsideration</a>, Dec. 21, 2016 <a href="/system/files/2018-02/161115replybriefaljdelay.pdf">AHA, Hospital reply brief</a>, Nov. 15, 2016 <a href="/content/16/160919staydeniedappeals.pdf">Government's motion for stay DENIED,</a> Sept. 19, 2016 <a href="/content/16/160701timelyappealsgovreplybrief.pdf">Government’s reply brief</a>, July 1, 2016 <a href="/content/16/160613briefopposstay-alj.pdf">AHA, Hospitals Brief Opposing Stay</a> June 13, 2016 <ul> <li><a href="/content/16/160613proporder-alj.pdf">Proposed Order Denying Stay, Declaring ALJ Delays in Violation of Medicare Law,</a> June 13, 2016</li> </ul> <a href="/system/files/2018-02/160525-hhsmotionmemo.pdf">Govt. Motion to Stay Proceedings on Remand</a>, May 25, 2016 <ul> <li><a href="/system/files/2018-02/160525-hhsdeclaration.pdf">HHS Declaration in Support of Motion for Stay</a>, May 25, 2016</li> <li><a href="/system/files/2018-02/160525proposedorder.pdf">Proposed Order for Granting Stay</a>, May 25, 2016</li> </ul> <a href="/content/16/160209-aljdelayappealdecision.pdf">ALJ Delay Mandamus Appeal:&nbsp; D.C. Circuit Court Reverses Lower Court's Decision</a>, Feb. 9, 2016&nbsp; <a href="/system/files/2018-02/150715ahareplybriefaljdelay.pdf">AHA, Hospitals reply brief in ALJ delay appeal</a>, July 15, 2015 <a href="/system/files/2018-02/150701govtreplyaljdelay.pdf">Government's reply brief in ALJ delay appeal</a>, July 1, 2015 <a href="/system/files/2018-02/150508-aljdelayappgranted.pdf">Government's request for extra time to file responsive brief in appeal granted</a>, May 8, 2015 <a href="/system/files/2018-02/150507aljdelay-oppexten.pdf">AHA, hospitals oppose request to extend time for government’s response</a>, May 7, 2015 <a href="/system/files/2018-02/150504briefaljdelay.pdf">Opening appeal brief from AHA, hospitals</a>, May 4, 2015 <a href="/content/14/141218-aljdelay-opinion.pdf">Court dismisses ALJ delay case</a>, Dec. 18, 2014 <a href="/content/14/141017hhsbriefappeals.pdf">Government's brief in support of its motion to dismiss</a>, Oct 17, 2014 <ul> <li><a href="/content/14/141017griswolddeclaration.pdf">Declaration of Nancy J. Griswold Chief Administrative Law Judge of Office of Medicare Hearings and Appeals</a></li> <li><a href="/content/14/141017cashdeclaration.pdf">Declaration of Lester D. Cash</a></li> </ul> <a href="/content/14/141002-alj-opposition-reply.pdf">AHA, Hospitals brief opposing govt. motion to dismiss, further supporting our motion for summary judgment</a>, Oct. 2, 2014 <a href="/content/14/140911govtoppostomsj.pdf">Government responds to AHA, Hospitals complaint and motion for summary judgment</a>, Sept. 11, 2014 <ul> <li><a href="/content/14/140911govtmotiontodismiss.pdf">Government's motion to dismiss</a></li> <li><a href="/content/14/140911tobiasdecl.pdf">Declaration of Constance B. Tobias</a> <ul> <li><a href="/content/14/140911ex1totobias.pdf">Exhibit 1&nbsp;</a>&nbsp;</li> </ul> </li> <li><a href="/content/14/140911griswolddecl.pdf">Declaration of Nancy J. Griswold</a> <ul> <li><a href="/content/14/140911ex1togriswold.pdf">Exhibit 1 </a></li> <li><a href="/content/14/140911ex2togriswolddecl.pdf">Exhibit 2 </a></li> </ul> </li> </ul> <a href="/content/14/140829minordbriefschedaljdelay.txt">Briefing Schedule Set in ALJ Delay Litigation</a>, Aug. 29, 2014&nbsp; MINUTE ORDER granting the parties' Joint [11] Motion for Briefing Schedule. The Court ORDERS that the Plaintiffs shall file a consolidated brief in opposition to Defendant's forthcoming Motion to Dismiss and reply in support of Plaintiffs' Motion for Summary Judgment, not to exceed forty-five pages, on or before October 2, 2014; and Defendant shall file a reply brief in support of her forthcoming Motion to Dismiss on or before October 17, 2014. Signed by Judge James E. Boasberg on 08/29/14. (lcjeb1) <a href="/content/14/140829motionsetbriefsched.pdf">Parties Jointly Request Briefing Schedule</a>, Aug. 29, 2014 <ul> <li><a href="/content/14/140829proporder.pdf">Proposed Order</a></li> </ul> <a href="/content/14/140722aljdelayextensiongranted.txt">Government's motion for extension of time to respond granted</a>, July 22, 2014 MINUTE ORDER GRANTING Defendant's 9 Motion for Extension of Time to Respond to Complaint and Plaintiff's Motion for Summary Judgment. The Court ORDERS that Defendant shall respond to the Complaint and to Plaintiffs' Motion for Summary Judgment on or before September 11, 2014. Signed by Judge James E. Boasberg on 7/22/2014. (lcjeb3) <a href="/content/14/140722-motion-denyhhsexten.pdf">AHA, Hospitals Oppose Government’s Request for Delay</a>, July 22, 2014 <ul> <li><a href="/content/14/140722-proporder-denyextension.pdf">Proposed Order</a></li> </ul> <a href="/content/14/140721-dojmotionextension.pdf">DOJ Requests 45-Day Extension to Respond to ALJ Delay Lawsuit</a>, July 21, 2014 <a href="/content/14/140711-judgesum-alj-delay-lawsuit.pdf">AHA, Hospitals’ Motion for Summary Judgment ALJ Delay Lawsuit</a>, July 11, 2014&nbsp;&nbsp; <ul> <li><a href="/content/14/140711-proporder-alj-delay-suit.pdf">[Proposed Order]</a></li> <li><a href="/content/14/140711-ex1-medadmin-appeals.pdf">Exhibit 1:&nbsp; Medicare Administrative Appeals Process</a></li> <li><a href="/content/14/140711-ex2-omha-2-12-slides.pdf">Exhibit 2: &nbsp;OMHA Feb 12 Forum Presentation Slides</a></li> <li><a href="/content/14/140711-ex3-omha-12-24-mem-mora.pdf">Exhibit 3:&nbsp; OMHA Dec 24 Memo re Moratorium</a></li> <li><a href="/content/14/140711-ex4.pdf">Exhibit 4:&nbsp; OMHA Adjudication Timeframes and Statistics</a></li> <li><a href="/content/14/140711-ex5.pdf">Exhibit 5:&nbsp; Results from AHA RACTRAC Survey, 1st Quarter &nbsp;2014</a></li> <li><a href="/content/14/140711-ex6.pdf">Exhibit 6:&nbsp; Article from Inside Health Policy - ALJs Lay Path Forward For Stakeholders As Appeals Backlog Continues</a></li> <li><a href="/content/14/140711-ex7.pdf">Exhibit 7:&nbsp; July 10, 2014 Statement of Chief ALJ Griswold before Subcommittee of the House Committee on Oversight and Government Reform</a></li> <li><a href="/content/14/140711-ex8.pdf">Exhibit 8:&nbsp; Feb. 12, 2014 AMA Letter to Chief ALJ Griswold re appeals backlog</a></li> <li><a href="/content/14/140711-ex9.pdf">Exhibit 9:&nbsp; March 27, 2014 AdvaMed letter to Sec. Sebelius re OHMA moratorium</a></li> </ul> <a href="/ahanews/jsp/display.jsp?dcrpath=AHANEWS/AHANewsNowArticle/data/ann_071114_motion&amp;domain=AHANEWS" target="_blank">AHA, hospitals ask court to compel HHS to meet hearing deadlines</a>,&nbsp;July 11, 2014 <a href="/system/files/media/file/2023/04/aha-hospitals-mandamus-complaint-to-compel-timely-administrative-review-of-Medicare-claims-denials-5-22-2014.pdf" target="_blank">AHA, hospitals mandamus complaint to compel timely administrative review of Medicare claims denials</a>, May 22, 2014&nbsp; <ul> <li><a href="/content/14/140522complaint-exhibit1.pdf">Exhibit 1</a></li> <li><a href="http://www.ahanews.com/ahanews/jsp/display.jsp?dcrpath=AHANEWS/AHANewsNowArticle/data/ann_052214_ALJ&amp;domain=AHANEWS">AHA News Now article</a></li> </ul> Tue, 20 Feb 2018 15:01:16 -0600 Recovery Audit Contractor (RAC) Reply brief in AHA, Hospitals' ALJ backlog mandamus order /legal-documents/2018-02-15-reply-brief-aha-hospitals-alj-backlog-mandamus-order <div class="body"> AHA, Hospitals' lawsuit to require HHS to meet deadlines for deciding appeals. &nbsp; Reply Memorandum in Support of AHA and Hospitals' Cross-Motion for Summary Judgment. Plaintiffs' summary-judgment motion granted. </div> Thu, 15 Feb 2018 12:03:46 -0600 Recovery Audit Contractor (RAC) Recovery Audit Contractor Program - Educational Resources /2017-12-11-recovery-audit-contractor-program-educational-resources <div class="outlineContent clearfix "><h1>AHA Audit Education Series</h1><div class="clearfix"><h4 align="left">Prior RAC Educational Events</h4><a href="/auditseries">Fall Audit Education Series Webinars (October - November 2012): Click here to view the video recordings</a> <img alt="Members Only" border="0" height="16" src="/images/membersonlygrey.gif" width="13" /><a href="/auditseries">Summer Audit Education Series Webinars (May - August 2012) : Click here to view the video recordings</a> <img alt="Members Only" border="0" height="16" src="/images/membersonlygrey.gif" width="13" /><a href="/advocacy-issues/rac/11novcmscalls.shtml">Members-Only Conference Call: Discussion with CMS and Your Medicare Recovery Audit Contractor</a> (Calls held November 1-4, 2011) <img alt="Members Only" border="0" height="16" src="/images/membersonlygrey.gif" width="13" />AHA Solutions Webinar: Navigating the RAC Appeals Process, August 24, 2011 <a href="http://wm.yourcall.com/AHA/AHA_Wadzinski_082411.wmv">View the replay of the webinar here.</a>AHA Solutions Webinar: Back to RACs - The Latest Insights &amp; Guidance from RAC Experts, March 23, 2011 <a href="http://www.surveymonkey.com/s.aspx?sm=3Mp8DCUw9Bkq7X81TmrREA_3d_3d">Order the free replay here.</a>Building an Effective Audit Rapid Response Team – Who, What, When, Where, Why and How? Are you prepared for a health care audit by a RAC, a MAC, a MIC, a ZPIC? May 12, 2010 <a href="http://www.surveymonkey.com/s.aspx?sm=3Mp8DCUw9Bkq7X81TmrREA_3d_3d">Order the free replay here.</a> May 12, 2009 &amp; April 22, 2009 - The Medicare Appeals Process<ul><li><div><a href="/content/2009/pdf/09appealscallslides.pdf">Presentation Slides (PDF)</a> <img alt="Members Only" height="16" src="/images/membersonlygrey.gif" width="13" /></div></li><li><div><a href="/content/2009/audio/090512racappealscall.mp3">Audio Recording of the May 12 call (MP3)</a> <img alt="Members Only" height="16" src="/images/membersonlygrey.gif" width="13" /></div></li><li><div><a href="/content/2009/audio/090422raccall.mp3">Audio recording of the April 22 call (MP3)</a> <img alt="Members Only" height="16" src="/images/membersonlygrey.gif" width="13" /> </div></li></ul>MAY 6, 2009- RACTrac claim level tool Webinar<ul dir="ltr"><li><div><a href="/content/2009/pdf/090506-RAC&lt;em&gt;Trac&lt;/em &gt;slides.pdf">Presentation Slides</a></div></li><li><div><a href="ractrac.shtml">To view the video files, visit RACTrac resources</a></div></li></ul>October 23, 2008 - ASHRM Audio-Conference: Medicare Recovery Audit Contractor (RAC) Program: Impact of RAC Audits &amp; RAC Update<ul dir="ltr"><li><div><a href="http://www.ashrm.org/ashrm/education/programs/audio/files/RAChandouts.pdf">Presentation Slides (PDF)</a> </div></li><li><div><a href="http://www.ashrm.org/ashrm/education/programs/audio/files/RAC102308.mp3">Audio recording of the call (MP3)</a></div></li></ul>October 21 and October 22, 2008 - CMS Discusses New RACs with AHA members<ul dir="ltr"><li><div><a href="/content/2008/pdf/08oct-cmsracslides.pdf">Presentation (PDF)</a> <img alt="Members Only" height="16" src="/images/membersonlygrey.gif" width="13" /></div></li><li><div><a href="/content/2008/audio/081021raccall.mp3">Audio file of the 10/21 RAC call (MP3)</a> <img alt="Members Only" height="16" src="/images/membersonlygrey.gif" width="13" /></div></li><li><div><a href="/content/2008/audio/081022raccall.mp3">Audio file of the 10/22 RAC call (MP3)</a> <img alt="Members Only" height="16" src="/images/membersonlygrey.gif" width="13" /></div></li></ul>October 8, 2008 - AHA Solutions Signature Learning Series Audio-Conference: The RACs&#x27; Latest Focus: Short Stay and High Cost Procedures. Are You In The RACs&#x27; Cross Hairs?<ul dir="ltr"><li><div><a href="/content/2008/pdf/081008EHR-raccall.pdf">Presentation slides (PDF)</a></div></li></ul>September 12, 2008 - <a href="http://online.krm.com/iebms/coe/coe_p2_details.aspx?eventid=13625&amp;oc=10&amp;cc=00286172P">CLICK HERE</a> for Prior RAC Education Series Events hosted by AHA Central Office.September 9, 2008 - <a href="/content/2008/pdf/080908-hillpres.pdf">Allied Executive Meeting, Medicare Recovery Audit Contractors (RACs) Program</a> <img alt="Members Only" height="16" src="/images/membersonlygrey.gif" width="13" /> Presentation by Timothy Hill, CFO for the Office of Financial Management, CMS<ul><li><div><a href="/content/2008/pdf/080908-hillpres.pdf">Presentation slides (PDF)</a> <img alt="Members Only" height="16" src="/images/membersonlygrey.gif" width="13" /></div></li></ul>June 18, 2008 - <a href="/content/2008/audio/080618-racprescah.mp3">AHA Member Call for CAHs on Medicare Recovery Audit Contractors (MP3)</a> <img alt="Members Only" height="16" src="/images/membersonlygrey.gif" width="13" /><ul><li><div><a href="/content/2008/pdf/080618-racpres-cah.pdf">Presentation slides (PDF)</a> <img alt="Members Only" height="16" src="/images/membersonlygrey.gif" width="13" /></div></li></ul></div><div class="ie"> </div></div> Mon, 11 Dec 2017 00:00:00 -0600 Recovery Audit Contractor (RAC) Recovery Audit Contractor (RAC) Program Regions - Region A /2017-12-11-recovery-audit-contractor-rac-program-regions-region <div class="outlineContent clearfix "> <h1>RACs FOR REGION A</h1> <ul> <li>Performant&nbsp;Recovery, Inc. of Livermore, California, in Region A, initially working in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island and New York</li> <li>PRG-Schultz USA, Inc. will act as a subcontractor to Diversified Collection Services, Inc.</li> </ul> <div class="clearfix">&nbsp; <hr /> &nbsp; <table align="center" border="1" bordercolor="#c0c0c0" cellpadding="8" cellspacing="0"> <tbody> <tr> <td align="center" bgcolor="#eaeaea" colspan="3" valign="middle"> <h4>REGION A<a id="a" name="a"></a></h4> </td> </tr> <tr> <td align="center" valign="top">Contractor Name</td> <td align="center" valign="top">Contact Information</td> <td align="center" valign="top">CMS RAC Staff Contact Information</td> </tr> <tr> <td valign="top"> Performant Recovery, Inc. Livermore, California &nbsp; PRG-Schultz USA, Inc. (subcontractor) </td> <td valign="top"> 1-866-201-0580 <a href="mailto:info@dcsrac.com">info@dcsrac.com</a> Website: <a href="http://www.dcsrac.com/">www.dcsrac.com</a> &nbsp; &nbsp; &nbsp; </td> <td> Tamara Tate Email: <a href="mailto:tamara.tate@cms.hhs.gov">tamara.tate@cms.hhs.gov</a> Phone: (410) 786-1288 Centers for Medicare and Medicaid Services Office of Financial Management 7500 Security Blvd. Baltimore MD, 21244 Mail Stop C3-09-13 </td> </tr> <tr> <td colspan="3"> State, Regional, and Metropolitan Hospital Association Staff Contacts (Members Only) <table align="left" border="0" bordercolor="#c0c0c0" cellpadding="4" cellspacing="0" width="100%"> <tbody> <tr> <td> <a href="/SIF/directory/connecticut.shtml">Connecticut</a> <a href="/SIF/directory/delaware.shtml">Delaware</a> <a href="/SIF/directory/washingtondc.shtml">District of Columbia</a> <a href="/SIF/directory/maine.shtml">Maine</a> </td> <td> <a href="/SIF/directory/maryland.shtml">Maryland</a> <a href="/SIF/directory/massachusetts.shtml">Massachusetts</a> <a href="/SIF/directory/newhampshire.shtml">New Hampshire</a> <a href="/SIF/directory/newjersey.shtml">New Jersey</a> </td> <td> <a href="/SIF/directory/newyork.shtml">New York</a> <a href="/SIF/directory/pennsylvania.shtml">Pennsylvania</a> <a href="/SIF/directory/rhodeisland.shtml">Rhode Island</a> <a href="/SIF/directory/vermont.shtml">Vermont</a> </td> </tr> </tbody> </table> &nbsp; </td> </tr> </tbody> </table> </div> <div class="ie">&nbsp;</div> </div> Mon, 11 Dec 2017 00:00:00 -0600 Recovery Audit Contractor (RAC)