Senate Finance Committee Raises Concerns About Medicare Appeals Office Problems

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Senate Finance Committee Chair Max Baucus (D-Mont.) and ranking member Chuck Grassley (R-Iowa) in a letter recently sent to HHS Secretary Mike Leavitt raised concerns about alleged problems in the Office of Medicare Hearings and Appeals, CQ HealthBeat reports. The letter cited a report issued in July by the HHS Office of Inspector General that found a number of problems at OMHA, an office established under the 2003 Medicare law to conduct administrative appeals previously heard by the Social Security Administration.

According to the report, 35% of appellants interviewed by HHS OIG said that OMHA employees did not allow them to conduct hearings through video teleconference, and the office has no standardized script or guidance manual to direct workers on the presentation of hearing options to appellants. In addition, the report found that OMHA often failed to meet a requirement to reach decisions on certain appeals within 90 days.

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The report found that OMHA failed to meet the requirement in 15% of such appeals with a decision date recorded and that half of such appeals did not have a decision date recorded. OMHA officials said that the office has taken steps to address the problems cited in the report, such as the implementation of training sessions for employees who schedule hearings and the resolution of technical issues associated with telephone and video teleconference hearings, according to the report.

Baucus and Grassley requested a response to their letter by Oct. 6 and asked Leavitt for monthly performance updates at OMHA. They also have asked HHS OIG to conduct a subsequent review of OMHA (Anderson, CQ HealthBeat, 10/1).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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