A day (or week) in the life of an OMHA ALJ?

[ksrunner]

I'm hoping a member of this board, either a current or a past OMHA ALJ, could provide us with a description of what a typical day (or week) in their job is like.  For example:

    - How many hours on average they spend per day in telephone hearings?

    - How many hearings they typically hold each week?

    - How is the rest of their day typically spent (e.g., preparing for hearings, reviewing proposed orders)?

    - How do they keep ahead of the big case load (approx 1,000 cases per year)?

    - How often, if at all, do they telework (it's my understanding from other posts that they are limited to one day per week)?

    - Any other relevant info.

Thanks in advance!

[tom b]

I was an OMHA judge for about a year, and now I work for a different agency. I enjoyed the OMHA work.  OMHA was my first ALJ gig.

I had significant trial and appellate judicial experience before I arrived at OMHA, so managing hearings was pretty easy. The hearings can be quite short if you are well prepared and have identified the critical issues beforehand; they will go on forever if you have not.

Many hearings involved a single appellant, usually a hospital or a consortium representing multiple hospitals.  Some of my colleagues would hear 10 or 20 of those at a time, but I found it better to limit them to 5 or so. My part was easy compared to the role that the attorney-advisors (opinion writers) had to play, and I could maintain a decent pace of 5-10 decisions per day (both cases from hearings and cases decided on the record only) without hurting anyone.

Telework is a difficult subject.  I saw my job on a couple of levels -- to conduct hearings and decide cases, certainly, but also to be a supervisor (it is actually part of the duties).  I could not see a good way to supervise while working from home, so I was in the office every day.  Other judges did it differently.  Before I left OMHA, the telework "privilege" was increased from 1 day per week to 2.

Case load was a big problem, although I found that I could do "omnibus" decisions for some groups.  I do not know how the Medicare Appeals Council reacted to them, as I left before they would have gotten up there.  I identified some processes for streamlining decision writing, and I think it helped.  I spent a lot of time, in particular, on shell decisions before I took on certain types of cases-- home health care, for example, and billing errors for physician services -- and while the front-loading took some time, once I heard the cases or reviewed the files the decisions flowed quickly.  Your ability to keep up is only as good as the strength of your legal assistant; I had a very good one.

I'll be happy to provide more information.

Respectfully,

[ksrunner]

tom b -

Thank you for your response. That is very helpful information.

So in terms of percentages, how much time per week did you spend in hearings, reviewing records in preparation for hearings, reviewing proposed orders, etc.?

That would be quite a daunting workload on the attorney-advisors. Did you end up writing any of your own decisions, or simply editing the proposed decisions that were prepared for you?

[tom b]

When I was an appellate judge, my view was that I did not have cases; the court did. Sure, everyone was responsible for a share of the cases, but if one viewed one's responsibility more to the institution and to the process than one's own statistics, the load seemed lighter.

I spent a lot of time with the attorneys trying to impress upon them that they were writing for the Secretary of Health and Human Services.  A lot of my day was spent with that "institution building" with not only the attorneys but my fellow judges.

I wrote a lot of decisions myself, in part because it was sometimes faster, in part because it was interesting.  I tried not to cherry-pick the interesting cases, though, as I thought it important to give the attorneys something to look forward to besides a pile of home health cases every day.  The HH cases were always very hefty, as frequently beneficiaries would be in HH for years.

I think it's fair to say that I spent about 2 or 3 times as much preparing for a hearing as I did in the hearing itself, and I frequently spent 3 or 4 times as much drafting/editing a decision for a hearing as I did in the hearing itself.  I got faster as I got more familiar with medical records and with the way the cases usually flowed.

I revised a lot of drafts, too, and I tried to educate the attorneys on what I did and why.  I came from a full military career, where an officer's job was first and foremost to train the next generation, and I thought it important to train the next crop of ALJ's (recognizing, of course, that I couldn't fix the "standing" litigation or experience requirements, but I could at least make them better writers and thinkers, more imaginative even; they, like counsel who appeared in front of me, tired of my reminding them that somebody paid for them to go to all three years of law school, so they may as well get their money's worth).

I don't know whether this fully answers your questions, and every one of the 80 or so ALJ's in OMHA had a slightly different technique.  It worked for me and, most important, for the appellants seeking their day in court.

As another poster put it, however, "your mileage might vary".

Respectfully,

[Propmaster]

Thank you for the information Tom B.

[ksrunner]

Tom B. --

Thank you again. I hope you don't mind me asking a couple of follow-up questions:

1) Your estimates about the amount of time spent preparing for a hearing and then writing/editing an opinion make sense. With that in mind, can a diligent OMHA ALJ and his/her staff reasonably expect to produce 1,000 decisions per year?

2) Related to my first question, can some Medicare appeals be resolved quickly with or without a hearing?

Thanks again Tom.

[tom b]

ksrunner: Sorry for the delay, but the snow has caused some problems.

Briefly in response to your two questions, "possibly" and "yes".

It's an ambitious, but attainable, goal for a first-year judge to decide 1000 appeals. I think I fell short by 100 or so in my scant 1 year at OMHA. Had I stayed on, I would easily have hit the mark, and more likely would have been between 1500 and 2000, and I think quality would not have been sacrificed at the altar of quantity. The earlier preparatory work I did on creating shells (including breaking some bad writing habits; eliminating long quotations of publicly available statutes, regulations, manuals; insistence on parallel citations between the Social Security Act and the official United States Code), and in devising methods for attacking certain recurring problems, would have allowed me and my team to give due process to appellants much more efficiently. If a decision is not timely, it is not due process.

By regulation, when there are no disputed fact issues, an ALJ on his own initiative may resolve a case "on the record," meaning no hearing. Additionally, if an appellant waives a hearing, an ALJ may resolve the case on the record.  I don't know that I ever took the initiative to resolve a case on the record, but I certainly did so in many cases where the appellant waived the hearing.  In my book, and there is plenty of case law to back this up, where there is waiver, there is no error.

Further in response to the second question, there are plenty of cases that lend themselves to a quick decision, because the procedure is not covered (most dental work, for example), or because the lower levels of appeal obviously misapplied the law.  You do yourself, your team, and the taxpayers a great boon by deciding those and moving on quickly.

I do not, however, recommend "free-lancing".  You have at OMHA 75 or 80 veterans to query about approaches and style; I encourage anyone at OMHA to get up on the network and do so.

Respectfully, Tom B

[sealaw90]

Tom B - It sounds like a great gig - why did you leave within the year?

Did the Coast Guard hire you as the new ALJ in some sweet location? IMHO, the BEST agency to get an ALJ position in.

Not trying to pry, just a little curious, I assume your prior life lent itself to another agency??? If it's too specialized that your anonymity would be destroyed, I understand.

[saaao]

Tom B., I don't know if you have any insight into this issue, but do you know how transfers between ODAR and OMHA (and vice versa) work? Do ALJ's transfer from agency to another with a specific location in mind or do they just get assigned an office once the transfer is approved? Do you know what is required for a transfer to happen? I know interagency transfers, particularly between ODAR and OMHA, are a point of interest for many people here.

[tom b]

Sealaw: I had an opportunity to get in on the ground floor of a new ALJ program (some would describe it as being a "plankowner"), so I left OMHA. You can e-mail me for more info, and I will gladly share.

Saaao: Because OMHA has but 5 locations, they normally advertise and fill vacancies as they occur, usually without relocation. At least, that is what I have observed. You can e-mail me too if that will help.

Respectfully, Tom b