American Hospital Association calls on CMS to address 'flaws and inaccuracies' in OIG audits

Kelly Gooch - Print  | 

The American Hospital Association is calling on CMS to take action regarding hospital compliance reviews conducted by HHS' Office of Inspector General.

In a letter dated Oct. 2, the AHA specifically asks CMS to improve how it reviews and implements the OIG audits.

"The OIG's hospital audits regularly include fundamental flaws and inaccuracies, both in the OIG's understanding and application of Medicare payment rules and in the procedures the OIG uses to conduct the audits," wrote AHA General Counsel Melinda Reid Hatton. "These flaws result in vastly overstated repayment demands, unwarranted reputational harm, and diversion of hospital and physician leaders' time from their core mission of caring for patients. The OIG's mistaken legal interpretations also result in uneven application of Medicare payment rules, both because only some hospitals are subject to OIG audits, and because there is a lack of consistency in the appeals process."

Ms. Hatton adds the impacts of the audits "are exacerbated because the OIG regularly extrapolates its findings to all claims in the audit period."

The AHA suggested CMS take five courses of action. These included extrapolating "only if there is a significant error rate" as well as "delay[ing] extrapolation until the appeals process is complete."

Read the AHA's full letter here.


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