AHA Sues HHS Over Medicare Payment Denials

In a federal lawsuit, the American Hospital Association and four healthcare providers accuse HHS of illegally denying hospitals Medicare payments for audited outpatient procedures.

The Chicago-based interest group for hospitals says in the complaint that HHS maintains an illegal policy of refusing to pay hospitals for Medicare outpatient services in cases where auditors retroactively conclude that inpatient care should have been delivered outside the hospital.

“What the federal government is doing is wrong, unfair and a clear violation of federal law,” said AHA President and CEO Richard Umbdenstock in a news release (PDF). The AHA stated in the release that although hospitals and auditors may have disagreed about the appropriate settings for care and subsequent reimbursement rates, government officials were not questioning the fact that needed services were delivered to the patients.

“Allowing government auditors to second-guess these difficult medical decisions about where to best treat a patient years later based on a cold record and then refuse to pay for that care is indefensible,” Umbdenstock said.

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This entry was posted in Centers for Medicare & Medicaid Services (CMS), cms, Latino health trend, Latino HIT, LISTA, LISTA Global Health IT, mHealth, National Latino Alliance on Health Information Technology. Bookmark the permalink.

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