By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health
On May 24, 2016, the American Hospital
Association (AHA) released a letter claiming that Audits of hospital
billing by the Office of Inspector General
) 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
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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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
Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620. KeyWords: Office of the Inspector General
and Human Services (HHS
), American Hospital
Association (AHA), hospital
compliance audits, audits of hospital
billing, excessive repayment demands, data
mining, possible overbilling, complianec, defense attorney
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Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health
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