The OIG has issued a report entitled “Improvements Are Needed at the Administrative Law Judge Level of Medicare Appeals.” The report discusses the impact of regulatory and organizational changes that went into effect in 2005 that required Medicare administrative law judges (ALJ) to follow new regulations addressing how to apply Medicare policy, when to accept new evidence, and how CMS participates in appeals. According to the OIG, in FY 2010, providers filed the 85% of ALJ appeals, while beneficiaries filed 11% and state Medicaid agencies filed 3%. ALJs reversed Qualified Independent Contractors (QIC) decisions and decided fully in favor of appellants in 56% of appeals, with the rate varying substantially across Medicare program areas and by ALJ. For instance, 62% of Part A ALJ appeals were fully favorable to appellants, compared to 59% for Part B, 18% for Part C, and 19% for Part D. The OIG notes that ALJs differed from QICs in their interpretation of Medicare policies, in their degree of specialization, and in their use of clinical experts. The OIG also found that when CMS participated in appeals, ALJ decisions were less likely to be favorable to appellants. The OIG concludes that there are a number of inconsistencies and inefficiencies in the Medicare appeals process that should be addressed. The report offers several recommendations for CMS and the Office of Medicare Hearings and Appeals (OMHA), including providing coordinated training on Medicare policies to ALJs and QICs; clarifying Medicare policies that are subject to different interpretations; improved guidance on the acceptance of new evidence by ALJs; improved handling of appeals from appellants who are also under fraud investigations; and increased CMS participation in ALJ appeals.