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AHA urges HHS to halt 'flawed' Medicare audits, recoupments

June 3, 2014

The AHA yesterday asked Health and Human Services Secretary Kathleen Sebelius to immediately stop flawed and redundant audits by HHS’ Office of Inspector General and recouping the estimated overpayment amounts. The OIG “hospital compliance reviews” are “entirely redundant” to Medicare Recovery Audit Contractor reviews and use “flawed sampling and extrapolation methods to estimate an overpayment amount,” wrote AHA Executive Vice President Rick Pollack. CMS “has allowed or may even have instructed its [Medicare Administrative Contractors] to recoup the OIG’s estimated overpayment amounts in violation of the statutory limits on MACs’ use of extrapolation and without following any of the Medicare rules or procedures for doing so or affording the hospitals the statutory and regulatory protections to which they are entitled. The Kafkaesque burden of imposing duplicative audits on hospitals and recouping payments from them without correcting the OIG’s manifold and glaring errors is abusive and unfair to hospitals and a waste of government resources.”