December 09,2015

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Hatch, Wyden Applaud Introduction of Bipartisan Bill to Overhaul Medicare Audit & Appeals Process

WASHINGTON – Senate Finance Committee Chairman Orrin Hatch (R-Utah) and Ranking Member Ron Wyden (D-Ore.) introduced S. 2368, the Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015, legislation to improve the Medicare audit and appeals process.  The bipartisan bill was reported out of the Committee earlier this year by a voice vote.

“This bipartisan legislation will implement much-needed reforms to the Medicare audit and appeals process without sacrificing quality care for patients,” Hatch said. “At a time where it takes up to a year and a half to process Medicare appeals, this bill addresses the massive backlog of Medicare appeals and offers more protection to beneficiaries and more certainty for healthcare providers. This a common-sense fix that will improve our healthcare system for both patients and providers, and I look forward to working with my colleagues on both sides of the aisle in getting this bill passed in the Senate.”

“I’m proud the Finance Committee has come together to make smart, common-sense changes to the audit and appeals system in Medicare so there is less red tape and the tremendous backlog of claims can be processed,” Wyden said. “The challenges facing the audits and appeals process today hurt providers, beneficiaries, and states, and it’s time to take action on these bipartisan reforms. I hope the Senate can swiftly take up and pass this bill.”


According to the Government Accountability Office (GAO), in fiscal year 2014, Medicare covered 54 million beneficiaries at a cost of $603 billion.  The non-partisan Congressional watchdog found that of the $603 billion, nearly ten percent, or $60 billion, in improper payments plague the Medicare system.  The Centers for Medicare & Medicaid Services (CMS), the agency charged with administering the program, has conducted audits on more than one billion claims in an effort to curb improper payments. The increasing number of audits has resulted in an uptick in Medicare appeals from service providers.  Currently, according to the Department of Health and Human Services (HHS), the Office of Medicare Hearing and Appeals is facing a backlog of nearly one million claims.

Additional information on the AFIRM Act can be found here.

A letter of support from the American Medical Association (AMA) can be found here.