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No. 3:14-cv-01230 (D.Conn.), filed August 26, 2014

Issue: Whether the consistent failure of administrative law judges (ALJs) to issue decisions within 90 days of the request for ALJ review (with an average delay now approaching 500 days) violates the Medicare statute and the Due Process Clause.

Relief sought: Declaratory and injunctive relief prohibiting the Secretary from not ensuring that ALJ decisions are issued within 90 days of the request for review, as the statute expressly requires.

Updated: October 13, 2016

Status: The complaint was filed on August 26, 2014, and plaintiffs' motion for certification of a nationwide class was filed the following week.  As a related case and at plaintiffs' request, the case was assigned to the same judge who is handling the "denial rate case" (Hull).  On January 29, 2015, the district judge ruled from the bench, denying the motion to dismiss.  On February 20, 2015, the Secretary responded to plaintiffs’ written discovery requests.  On June 10, 2015, the court granted plaintiffs’ motion and certified a nationwide class.  Exley v. Burwell, 2015 WL 3649632 (D.Conn. 2015).

The parties engaged in extensive settlement discussions during the latter part of 2015 and early 2016.  On March 2, 2016, the district judge gave preliminary approval to a proposed settlement agreement.  That settlement would require the Secretary to give priority to beneficiary requests for ALJ review for three years after the settlement is approved and to provide a more user-friendly appeal form for beneficiaries.  Plaintiffs can enforce the settlement during that three-year period.

After a delay caused by the Secretary’s request to change some of the wording of the proposed settlement, the fairness hearing was held on August 1.  The only objection to the settlement was not sufficient to dissuade the judge from approving the settlement, which he did on the same date.  Plaintiffs’ counsel will be monitoring to ensure that the terms of the settlement are carried out. 

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