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    Hurry Up and Wait: Our Broken Medicare Appeal System
    Hurry Up and Wait: Our Broken Medicare Appeal System
    Hurry Up and Wait: Our Broken Medicare Appeal System
    Ebook120 pages1 hour

    Hurry Up and Wait: Our Broken Medicare Appeal System

    By Bob Soltis

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    About this ebook

    Did you know the time for your healthcare provider's Medicare hearing has skyrocketed from the Congressionally mandated three months to over three years?

    Did you want to know why the good ship OMHA has been swamped?

    Did you know the crisis affects all of us, and that we must act now before the 2016 budget is passed?

    Would it surprise you that the bill pending in Congress to address the backlog of over 600,000 cases - the AFIRM (Audit & Appeal Fairness, Integrity and Reforms in Medicare Act) is not a panacea?

    Do you want straight talk from a former ALJ about what's going on at Medicare (CMS) and in the Office of the Chief Judge?

    Can you imagine a system that works for us, not for "them?"
    LanguageEnglish
    PublisherLulu Publishing Services
    Release dateAug 20, 2015
    ISBN9781483434964
    Hurry Up and Wait: Our Broken Medicare Appeal System

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      Book preview

      Hurry Up and Wait - Bob Soltis

      Hurry Up

      and Wait

      Our Broken Medicare

      Appeal System

      Bob Soltis

      Copyright © 2015 Bob Soltis.

      All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means—whether auditory, graphic, mechanical, or electronic—without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.

      ISBN: 978-1-4834-3497-1 (sc)

      ISBN: 978-1-4834-3496-4 (e)

      Library of Congress Control Number: 2015911215

      Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

      Any people depicted in stock imagery provided by Thinkstock are models, and such images are being used for illustrative purposes only.

      Certain stock imagery © Thinkstock.

      Lulu Publishing Services rev. date: 7/29/2015

      CONTENTS

      About the Author

      Preface

      THE TIDAL WAVE

      Chapter 1:   An Overview of Medicare

      Chapter 2:   The Appeal Process

      Chapter 3:   The Bull in the China Shop

      Chapter 4:   We Are Experts on Excuses

      Chapter 5:   Drowning in a Sea of Claims

      Chapter 6:   Another Day, Another Deputy Director

      Chapter 7:   Paralysis by Analysis

      Chapter 8:   Paper, Paper Everywhere, but We Can’t Find Your Case

      Chapter 9:   The Backroom Deal

      Chapter 10:   The Reward for Work Is More Work

      BRIDGING TROUBLED WATERS

      Chapter 11:   Too little too late?

      Chapter 12:   The Blame Game

      Chapter 13:   Reining in the RACs

      Chapter 14:   Slogan, or solution?

      Chapter 15:   Common-Sense Ideas

      GETTING BACK ON COURSE

      Chapter 16:   Help Is on the Way

      Chapter 17:   The Elephant in the Room

      Chapter 18:   Decisions, Decisions

      Chapter 19:   Honesty Is the New Policy

      Chapter 20:   Agreeing about Disagreeing

      Chapter 21:   Which Way, OCALJ?

      A CALL TO ACTION

      Chapter 22:   Si, Se Puede

      Acknowledgments

      Excerpt from Objection Sustained!

      ABOUT THE AUTHOR

      From everyone who has been given much, much will be required.

      Luke 12:48

      Bob Soltis is America’s authority on Medicare hearings. As an administrative law judge, he presided over Medicare hearings from 2006 until he took early retirement in 2015 to write this book and Objection Sustained: Standing Up to Contractor Kibitzing at your Medicare Hearing. His administrative agency career began in 1971 when he was appointed an ex officio member of the Gary Redevelopment Commission. Before being appointed to the administrative judiciary, Bob taught attorneys and non-attorneys to artfully present their causes and write better decisions. He has represented thousands of clients before administrative agencies, including the Medical Board of California, military Physical Evaluation Boards, the Defense Office of Hearings and Appeals, the National Reconnaissance Office, the Illinois Industrial Commission, and the Social Security Administration. A former Navy Officer in the Judge Advocate General’s (JAG) Corps, Bob earned a BA in biology from Indiana University and a law degree from DePaul University.

      PREFACE

      Next time you think they should do something, remember: You are now they.

      —Commencement speaker,

      Officer Indoctrination School, 1989

      In August 2006, I got the call I had been waiting for: Congratulations, you’ve been appointed a United States administrative law judge. So I packed up and drove east to a job many lawyers dream of but for which few are chosen.

      Under Chief Judge Perry Rhew’s leadership, the Office of Medicare Hearings and Appeals (OMHA) was one of the America’s best places to work. Judge Rhew was out and about within the four field offices, he knew everyone’s name, and he kept OMHA out from under the thumb of the Center for Medicare and Medicaid Services.

      Things changed after Judge Rhew left in 2010. The Center for Medicare and Medicaid Services (CMS) stepped up its review of cases it had previously paid, hiring collection agents called Recovery Audit Contractors (RACs) to sift through past payments for reasons to take the money back. Over the last three years, those collection agents have become even more aggressive, and the hospitals they targeted filed a tidal wave of appeals that swamped the good ship OMHA’s ability to hear those appeals within the ninety days Congress allowed them to get it done.

      The water keeps pouring in with no end in sight.

      Instead of coming clean about the problem, standing up to CMS mediocrity, and hiring more worker bees, the Office of the Chief Administrative Law Judge (OCALJ) hired more headquarters staff, gave them fancy titles, and rearranged its organizational chart. After the stuff hit the rotating blade in December 2013, OCALJ finally convened a public forum for appellants on February 12, 2014. Instead of taking responsibility and offering solutions, the Office of the Chief Judge squandered that opportunity by wasting five hours of appellants’ time attempting to explain the crisis away.

      The continued mediocrity at HHS, CMS, and the Office of the Chief Judge convinced me that my ladder has been leaning against the wrong wall. For years I have said, Someone needs to do something about the Office of the Chief ALJ. The penny finally dropped. Someone is me. As our OIS commencement speaker would say, I am now they.

      Why should you care? CMS and OCALJ have wasted millions of your tax dollars in the last four years. If you’re a doctor or supplier, it will be three years before you have a hearing. If you’re a Medicare beneficiary, your doctors’ and providers’ quality of life has worsened while they wait for their hearings.

      Why this book? To solve a problem, you must first understand the problem and its causes before taking action. As the tidal wave of backlogged cases at OMHA approaches the half-million mark, it’s time for straight talk about what has become a crisis for anyone

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