AHA calls for halt of OIG compliance reviews
- The American Hospital Association is urging HHS to halt immediately its Office of Inspector General's hospital compliance reviews. In a June 2 letter, AHA called the OIG audits "entirely redundant" to reviews by Medicare Recovery Audit Contractors. Both focus on the same types of claims, such as short inpatient stays, AHA said.
- AHA asserts that the OIG's audit findings and estimated payments are incorrect, because the OIG has "misconstrued and misapplied" numerous Medicare regulations and policies and then used "flawed sampling and extrapolation methods to estimate an overpayment amount."
- AHA further contends that OIG publishes audits with inflated overpayments, and forwards them to CMS for recoupment without crediting hospitals for Part B payments for care provided during inpatient stays that the OIG concluded should have been provided on an outpatient basis.
Imposing duplicative burdens on hospitals and recouping payments from them without correcting errors in the process is unfair and a waste of government resources, AHA insists. Yet CMS says the RAC program has succeeded in reducing improper Medicare payments — to the tune of recouping several billion dollars in overpayments to providers since the national program began in 2009.
Of note: RAC recoveries aren't as high as they were a year ago, possibly due to a moratorium on review claims that may violate short-stay rules and delays in granting new contracts to RACs. AHA recently sued HHS, claiming the backlog for appealing claims audits has become too burdensome; and at least one watchdog group worries that continued pressure from the hospital industry is crippling the Medicare oversight program.
- www.beckershospitalreview.com AHA: Stop "Flawed" and "Redundant" OIG Hospital Compliance Reviews
- www.aha.org AHA's June 2 Letter to HHS Secretary Kathleen Sebelius
- www.fiercehealthfinance.com OIG: RAC collections drop