AHA Asks for Relief from OIG Medicare Audits

The American Hospital Association (AHA) submitted a letter to CMS dated June 2, 2014 stating concerns regarding Medicare audits or “hospital compliance reviews” performed by the Office of Inspector General (OIG) Office of Audit Services.  The AHA also takes issue with the use of extrapolation in these Medicare audits.

The AHA urged CMS to put an end to these OIG Medicare audits for the following reasons:

  1. The OIG audits are redundant to the Recovery Audit Contractor (RAC) reviews including the focus on short inpatient stays;
  2. The OIG’s audit findings and estimated overpayments are incorrect based on “misconstrued and misapplied Medicare regulations and policies” and “exacerbated by flawed sampling and extrapolation methods;”
  3. The OIG is not crediting the hospitals for the Part B stay for which payment should have been made even if the audit finding is correct, thus overstating the amounts at issue;
  4. The recoupment by the MACs is in violation of the statutory and regulatory protections to which the hospitals are entitled, including the “provider without fault” presumption contained in Section 1870 of the Social Security Act.

For additional information on Medicare audits and the appeal of such audits, please see our Medicare Appeals Resource page.

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