Medicare Claims: HCFA (Health Care Financing Administration) Proposal to Establish an Administrative Law Judge Unit.

This report briefed certain of your offices on our work relative to the requirement in section 4037 of the Omnibus Budget Reconciliation Act of 1987 to study the Health Care Financing Administrations HCFA proposal to establish, at a cost of about 15 million, its own hearings and appeals unit to handle Medicare cases. A special feature of this proposal was HCFAs projection that administrative law judges ALJs located in this unit would handle 50 percent of the appeals over the telephone. HCFAs proposal was presented to the Congress for funding in the fall of 1987 the proposal was not approved primarily because of congressional concerns about conducting the hearings by telephone rather than face-to-face. We reviewed HCFAs documentation for its proposal and met with Department of Health and Human Services HHS officials responsible for developing the proposal and Office of Personnel Management officials responsible for approving and monitoring ALJs in federal agencies. We also discussed the proposal with health service provider associations, national associations representing the elderly, and Medicare claims processing contractors who currently use telephone hearings.