DHHS Hearing Officer’s “Final Decision” Is NOT Final

You can appeal a Notice of Decision from DHHS! (And, usually, it is a very good idea).

Health care providers, who:

1.  Received Tentative Notices of Overpayment,

2.  Underwent a reconsideration review with DHHS,

3.  And still did not agree with the DHHS Hearing Officer’s Notice of Decision


The Hearing Officer’s decision is NOT final. It is appealable. But you do not have a long time to decide to appeal. You have only sixty (60) days from the date of the DHHS decision. Note: This means that you have less than 60 days, depending on how long the post office took to get the mailed DHHS decision to you.

If a health care provider has gotten to this point on his or her own….That’s great! But, at this point, serious consideration needs to weighed as to whether to obtain an attorney. (This is not an advertisement for me. In fact, I am in no way suggesting you call me. Just call a lawyer somewhere, not necessarily me).

After the reconsideration review, which is extremely informal, the next appeal goes to the Office of Administrative Appeals (OAH).  An OAH judge is assigned. And, at this point, the case gets assigned to an assistant Attorney General for the State. This is the point in which the state “lawyers-up.” This is the basis for which I state that a health care provider should obtain counsel at this time (not necessarily me).

An OAH appeal is not super-formal. It’s less formal than superior court.  The Rules of Civil Procedure are used, but used less stringently.  Also, procedure in OAH follows its own administrative rules, which can be found in Rules for the Office of Administrative Hearings, Hearings Division. The rules are not super difficult, but it is important to be aware of the administrative rules.

My basic message here, in this blog, is: Health care providers who disagree with the decision from DHHS need to appeal. All the legal mumbo jumbo can be scary and stressful. But do NOT back down. Know your rights. If you feel that the decision is unfair or too high, fight it. Appeal it.


About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on January 4, 2013, in Medicaid, Medicaid Appeals, Medicaid Recoupment, NC DHHS, North Carolina, OAH, Petitions for Contested Cases and tagged , , , , , , , . Bookmark the permalink. 1 Comment.

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