The American Hospital Association (AHA) is continuing its campaign against the ongoing hospital compliance reviews conducted by the Department of Health and Human Services (HHS) Office of Inspector General (OIG), which it says are not conducted fairly.
Melinda Reid Hatton, JD, senior vice president and general counsel of the AHA, recently sent a letter to OIG following up on earlier criticisms of the compliance reviews.
“We continue to be very troubled by the OIG’s decision to extrapolate its findings despite the numerous legal defects that we previously identified in these audits, the very damaging effects on hospitals’ reputations from publication of these alleged Medicare overpayments, and the similarly negative impact on the financial condition of our members that results from repayment of the vastly overstated amounts,” she wrote in the letter. (The most recent letter is available online at http://bit.ly/25o5f0A. The earlier letter is available online at http://bit.ly/1WmLjWR.)
AHA contends that the audits waste HHS resources and are unduly burdensome to hospitals, use extrapolation in a way that compounds OIG’s erroneous interpretations of Medicare rules and policies, and allow Medicare Administrative Contractors to collect overpayments in violation of the Medicare statute and agency rules.
OIG has responded to the AHA’s previous complaints, saying that determining overpayment through sampling and extrapolation, rather than reviewing each claim, is “both economical and in the best interest of the provider and the Government. OIG uses a conservative method under which overpayment estimates will almost always be lower than the estimates that would result from reviewing every claim.” (The OIG’s response is available online at http://1.usa.gov/1WmJdWO.)