Medicare

Pursuant to a congressional request, GAO provided statistical information on administrative law judge (ALJ) hearings concerning appeals of Medicare Part B eligibility determinations, focusing on: (1) the number and status of ALJ cases filed; (2) case outcomes by type of hearing; and (3) the amount of time needed to complete the hearing process.

GAO found that: (1) the Social Security Administration's (SSA) Office of Hearings and Appeals (OHA) had received 5,862 requests for ALJ hearings as of June 1989, with the most requests originating from the Dallas region and the fewest requests originating from the Seattle region; (2) 4,346 cases were pending in the OHA Development Center, which reviewed cases for completeness and conformance with procedural requirements, 343 were pending in SSA regions, and 1,173 were closed; (3) OHA dismissed about half of the closed cases for procedural problems or because claimants withdrew them; (4) the Kansas City region closed the largest percentage of cases, and the Dallas region closed the smallest percentage; (5) almost two-thirds of Dallas-closed decisions were favorable to claimants, as compared to 16 percent of Chicago decisions; (6) 40 percent of claimants who chose in-person hearings had favorable outcomes, as opposed to 26 percent of claimants who chose on-the-record hearings; (7) 35 percent of claimants chose in-person hearings; and (8) cases involving on-the-record hearings took an average of 154 days to close, while cases involving in-person hearings took an average of 299 days.