Data on ALJ Overturn Rates Over the Years

Here’s data from the Office of Medicare Hearings and Appeals showing how providers are faring with administrative law judges (ALJs) in the Medicare appeals process.[1] Providers are winning fewer appeals these days. “It is not the same provider-friendly environment it once was,” said attorney Jessica Gustafson at the National Physician Advisor Conference April 12.[2] “But it’s not as bad as the data would suggest.” The reason is the rate of dismissals has increased significantly, from 12.5% in 2012 to 46.9% in 2021. Contact Gustafson at jgustafson@thehlp.com.

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