Letter From Industry Group Claims OIG’s Audits Billing Contain Legal Defects

George Indest HeadshotBy 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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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, defense attorney, legal representation for audits, health law, The Health Law Firm

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