administrative law judge (ALJ)

What is an administrative law judge?

An administrative law judge is the officer of the court who presides over proceedings when a Medicare beneficiary (enrollee), medical provider, or supplier files an appeal, objecting to a decision made by Medicare Part A, Part B, Part C (Medicare Advantage) or Part D (prescription drug coverage).

The administrative law judge handles appeals that have reached the Office of Medicare Hearings and Appeals (OMHA), which means that lower-level appeals have not been successful.¹

Administrative law judges are hired by the U.S. Department of Health & Human Services. They must have at least seven years of experience as a licensed attorney, and meet various other criteria.²