The American Hospital Association (AHA) has again complained to the Centers for Medicare & Medicaid Services about “serious problems’’ with the hospital-compliance reviews by the Office of the Inspector General (OIG) of the Department of Health & Human Services.
AHA complained last week that the audits routinely include “fundamental flaws and inaccuracies, both in the OIG’s understanding and application of Medicare payment rules and in the procedures the OIG uses to conduct the audits.” The hospital trade organization asserted that this causes very overstated repayment demands, undermines hospitals’ reputations and steals time and resources from patient care.
The association added that the audits can lead to uneven and unfair application of Medicare payment rules. It notes that some hospitals aren’t audited and the appeals process operates inconsistently
Healthcare Dive noted that: “This is not a new issue for hospitals. In a June 2014 letter to then-HHS Secretary Kathleen Sebelius, the AHA called for an immediate halt to the audits, saying the OIG’s findings and estimated payments were incorrect and ‘entirely redundant.’ A recent uptick in penalties for alleged reimbursement fraud and abuse has galvanized hospitals to again press for audit reforms.
“AHA says OIG’s tendency to extrapolate its findings to all claims in an audit period is aggravating the problem of overall flawed reports.’’
The news service speculated: “The AHA may be hoping HHS scales back the review process altogether, which would not be particularly surprising with the pressure in President Donald Trump’s administration to roll back regulatory burden. Recently, the CMS said it will take a more targeted approach in some areas to finding and investigating Medicare fraud and improper payments. It will focus on providers whose claim error rates or unusual billing practices stand out compared to similar providers.’’
“But while hospitals call for reforms in the OIG compliance reviews, a recent Wall Street Journal report raised serious concerns about hospital safety. Reviewing hundreds of Joint Commission inspection reports, the Journal found about 350 hospitals that maintained accreditation in 2014 despite Medicare violations. More than a third of those had additional deviations in 2015 and 2016.’’
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