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About OMHA

The Office of Medicare Hearings and Appeals (OMHA) is responsible for Level 3 of the Medicare claims appeal process; certain Medicare entitlement appeals; Part B and Part D premium appeals.

OMHA was created by the Medicare Modernization Act of 2003 to simplify the appeals process and make it more efficient. During an appeal, an OMHA Administrative Law Judge conducts a new ("de novo") review of an appellant's case and issues a decision based on the facts and the law.

The Chief Administrative Law Judge leads the entire agency, which consists of six field offices and a headquarters office. Each field office includes many Administrative Law Judges who are overseen by an Associate Chief Administrative Law Judge.  Appeals are assigned to these Administrative Law Judges by a Centralized Docketing Division in accordance with standardized procedures.

Contact information for each OMHA field office is available

Operating Plan

Office of Medicare Hearings and Appeals (OMHA)

Operating Plan for FY 2015 - 2016 (Dollars in Millions)

Activities FY 2015 FY 2016
OMHA 87.381 107.381
OMHA Total 87.381 107.381

 

Organizational Chart

See how our office is structured and find information on key personnel.

Workload Information and Statistics

Find data about OMHA’s current workload, including decision statistics and average processing time.

Health Data Sets

Find data sets on receipts by fiscal year, appeal category, procedure, and state.

Special Initiatives

Learn how OMHA is working to improve the Medicare appeals process through pilot programs and other special initiatives.

Information about the Medicare Appeals Backlog

Learn the basics about the Medicare Appeals process and the current backlog in “HHS Primer: The Medicare Appeals Process” (PDF - 521 KB)

Content created by Office of Medicare Hearings and Appeals (OMHA)
Content last reviewed on July 25, 2016