By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in
Health Law
On May 24, 2016, the American
Hospital Association (AHA) released a letter claiming that Audits of
hospital billing by the
Office of Inspector General (
OIG) of the U.S.
Department of Health and Human Services (
HHS) contain numerous legal defects. According to AHA, the defects result in wildly excessive repayment demands.
Hospital Compliance Reviews.The letter from AHA relates to
hospital compliance reviews conducted by the
OIG. Scores of reviews have been conducted in recent years by the
OIG, which uses
data mining to identify possible overbilling and select
audit targets.
In its letter, the AHA focused primarily on the
OIG's practice of directly auditing a sample of billing claims and then generalizing the findings to a larger universe of claims. According to the AHA, there was an expectation recently that the use of extrapolation would be winding down, but that "unfortunately has not occurred."
"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 association’s spokesperson said, adding that repayment demands are often "vastly overstated."
To read the letter from AHA,
click here.
OIG Defends Its Audit Practices.In the past, the
OIG has defended its
audit practices and rejected legal objections raised by the AHA. According to
OIG records, there have been about 150
hospital compliance reviews since 2011. To read the letter from the
OIG defending its
audit practices,
click here.
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Source:Overley, Jeff. “
OIG Audits Laden With 'Legal Defects,' AHA Says.” Law360. (May 24, 2016). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in
Health Law. He is the President and Managing Partner of The
Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area.
www.TheHealthLawFirm.com The
Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
KeyWords: Office of the Inspector General (
OIG),
Health and Human Services (
HHS), American
Hospital Association (AHA),
hospital compliance audits, audits of
hospital billing, excessive repayment demands,
data mining, possible overbilling, complianec,
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health law, The
Health Law Firm
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Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The
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