Federal auditors are illegally "clawing back" hundreds of millions of
Medicare dollars over minor patient treatment decisions, and getting a
cut based on how much they can take back, the American Hospital
Association claims in court.
Joining as plaintiffs with the American Hospital Association (AHA), which represents nearly 5,000 hospitals, are three individual hospitals and Trinity Health Corp., a Catholic chain that owns 35 hospitals and manages 12 more.
They sued Health and Human Services Secretary Kathleen Sebelius in Federal Court, claiming the arbitrary clawbacks violate federal law.
The hospitals say the Centers for Medicare & Medicaid Services hire Recovery Audit Contractors, (RACs), and give them free range to "overrule physicians' expert medical judgments long after the fact, determining that particular Medicare patients - patients whom they have never even seen - should not have been admitted to the hospital to receive inpatient care."
These auditors deny "hundreds of millions of dollars" in Medicare treatments, the hospitals say, and are paid a percentage of what they can grab.
"In the first quarter of 2012 alone, information provided to the AHA by hospitals shows that they were forced to repay $236 million for medically necessary items and services that RACS deemed should have been provided on an outpatient, rather than an inpatient, basis," the AHA says.
The hospitals claim the auditors make their arbitrary decisions months and sometimes years after the decision to admit the patent has been made.
Read more: http://www.courthousenews.com/2012/11/05/51972.htm
Joining as plaintiffs with the American Hospital Association (AHA), which represents nearly 5,000 hospitals, are three individual hospitals and Trinity Health Corp., a Catholic chain that owns 35 hospitals and manages 12 more.
They sued Health and Human Services Secretary Kathleen Sebelius in Federal Court, claiming the arbitrary clawbacks violate federal law.
The hospitals say the Centers for Medicare & Medicaid Services hire Recovery Audit Contractors, (RACs), and give them free range to "overrule physicians' expert medical judgments long after the fact, determining that particular Medicare patients - patients whom they have never even seen - should not have been admitted to the hospital to receive inpatient care."
These auditors deny "hundreds of millions of dollars" in Medicare treatments, the hospitals say, and are paid a percentage of what they can grab.
"In the first quarter of 2012 alone, information provided to the AHA by hospitals shows that they were forced to repay $236 million for medically necessary items and services that RACS deemed should have been provided on an outpatient, rather than an inpatient, basis," the AHA says.
The hospitals claim the auditors make their arbitrary decisions months and sometimes years after the decision to admit the patent has been made.
Read more: http://www.courthousenews.com/2012/11/05/51972.htm
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