News: Recovery Auditors on the hot seat: Suit filed against HHS
November 8, 2012
CDI Strategies - Volume 6, Issue 23
On October 16, Representative Sam Graves (R-MO) introduced legislation to reform Recovery Auditors (RA) through various financial penalties and program limitations. (Read a related article in CDI Strategies.)
On November 1, the American Hospital Association (AHA) and four health systems filed suit in the U.S. District Court in Washington, DC, against the U.S. Department of Health and Human Services (HHS) for unfair Medicare practices pertaining to the Recovery Auditor program.
Plaintiffs the AHA, Missouri Baptist Sullivan Hospital (Sullivan MO), Munson Medical Center (Traverse City, Mich.), Lancaster General Hospital (Lancaster, Pa.), and Trinity Health Corporation (Livonia, Mich.) claim that the Medicare program has been
“refusing to pay hospitals for hundreds of millions of dollars’ worth of care provided to patients, even though all agree that the care provided was reasonable and medically necessary as the Medicare Act requires.”
The plaintiffs allege that the government’s refusal to pay harms hospitals and patients, violates the Medicare Act, and is unlawful. They want the court to overrule HHS’ policy and order the department to reimburse hospitals that have been denied payment.