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HHS FY2015 Budget in Brief

Department of Health and Human Services
Office of the Secretary, Office of Medicare Hearings and Appeals (OMHA)

The Office of Medicare Hearings and Appeals provides an independent forum for the fair and efficient adjudication of Medicare appeals for beneficiaries and other parties. This mission is carried out by a cadre of knowledgeable Administrative Law Judges (ALJ) exercising judicial and decisional independence under the Administrative Procedures Act, with the support of a professional, legal, and administrative staff.

OMHA Budget Overview

(Dollars in millions)






Program Level






Full Time Equivalents

2013: 492

2014: 514

2015: 629

2015 +/- 2014: +115

OMHA Activities

The FY 2015 Budget request for the Office of Medicare Hearings and Appeals (OMHA) is $100 million, an increase of $18 million over FY 2014. OMHA administers hearings and appeals nationwide for the Medicare program. By statute, these Medicare appeals are to be heard within 90 days after receipt of a request for a hearing from a Medicare appellant.

OMHA administers appeals in four field offices: Southern (Miami, Florida), Midwestern (Cleveland, Ohio), Western (Irvine, California), and Mid Atlantic (Arlington, Virginia). OMHA extensively utilizes hearings held via video teleconference and telephone in order to provide appellants with accessible hearings at low cost.

OMHA began processing cases on July 1, 2005; since then, it has received more than two million claims nationwide for Medicare Parts A, B, C, and D appeals, as well as for Medicare entitlement and eligibility appeals. In FY 2011, OMHA began receiving additional claims resulting from the permanent nationwide expansion of the Recovery Audit Contractor program, administered by the Centers for Medicare & Medicaid Services. These claims, in combination with the influx of Medicare enrollees due to retirement of baby boomers, have been driving OMHA’s workload upward at a rapid pace. OMHA received a total of 320,000 claims in FY 2012, and over 600,000 claims in FY 2013. OMHA projects that its FY 2015 caseload will increase to approximately 850,000 total claims (a 166 percent increase over FY 2012).

Due to the overwhelming growth in the caseload, OMHA is not able to meet the required 90 day timeframe for case adjudication. It is currently taking over 300 days for OMHA to adjudicate an appeal. OMHA’s backlog of claims is projected to reach 1,000,000 by the end of FY 2014.

With the requested funding level of $100 million, OMHA will increase its ALJs and support staff necessary to respond to the increasing number of Medicare appeals while maintaining the quality and accuracy of its decisions. OMHA will continue to utilize technology to offer appellants access to multiple hearing venues and service.

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Content created by Office of Budget (OB)
Content last reviewed on June 4, 2014