AHA wants OIG to stop claims audits

Trade group argues agency duplicates the work of RACs
Tools

Hospitals are pushing back against audits conducted by the U.S. Department of Health and Human Services' Office of the Inspector General, claiming they are redundant and burdensome versions of the lookbacks by recovery audit contractors (RACs) already underway, AHA News Now reported.

In a June 2 letter to outgoing HHS Secretary Kathleen Sebelius, AHA Executive Vice President Rick Pollack asked her agency to reconsider audits conducted by the OIG.

"These OIG audits are entirely redundant to the Medicare Recovery Audit Contractor (RAC) reviews that have burdened hospitals for many years now," Pollack wrote. "The OIG reviews have focused on the same types of claims--such as short inpatient stays--that have been under scrutiny by the Medicare RACs for quite some time."

Pollack also contended that the extrapolation methodologies used by the OIG is flawed, leading to incorrect overpayment estimates that lead to recoupment demands issued to hospitals. Moreover, the follow-up audits by OIG also violated regulations in place governing reopening of claims after four years have passed, he said. He termed the OIG's audits "Kafkaesque" and "abusive and unfair to hospitals and a waste of government resources."

Hospitals have been chafing about audits that have clawed back billions of dollars in overpaid claims since the RAC program was established five years ago. The AHA's lobbying has led to a moratorium on some forms of RAC audits, as well as the implementation of the two-midnight rule, which is expected to provide clarity to what is considered a short-term hospital stay. The OIG recently announced a drop in RAC-related collections.

It is unclear if Sebelius, who announced in April she was leaving the agency, will act before she departs, or if her replacement, Sylvia Mathews Burwell, who was confirmed by the U.S. Senate only yesterday, will take any action.

To learn more:
- read the AHA News Now article
- read the AHA letter to Secretary Sebelius (.pdf)

Related Articles:
OIG: RAC collections drop
CMS to suspend RAC requests
AHA, hospitals sue HHS over delays in RAC adjudication
OIG: CMS stuck with $543M in 'not collectible' overpayments
CMS lowers RAC medical record request limits
Senate confirms Mathews Burwell as HHS secretary