News & Perspectives

U.S. District Court in Wisconsin holds that DHHS is not bound by ALJ decision

9. July 2020 Sam Fish Health

On Monday, July 6, 2020, the U.S District Court for the Eastern District of Wisconsin held that the United States Department of Health and Human Services (DHHS) is allowed to deny Medicare payment for a brain cancer patient’s treatment despite approval of similar claims by an administrative law judge (ALJ), because ALJ decisions are not binding on the agency.

The District Court concluded that an ALJ decision does not have preclusive effect because it is not a final decision on the determination of a Medicare claim.