American Hospital Association Sues HHS for Illegally Refusing Medicare Payments

The American Hospital Association (AHA) and four healthcare providers are suing the Department of Health and Human Services (HHS) in federal court, accusing the agency of illegally withholding Medicare payments from hospitals for audited outpatient procedures.

AHA, based in Chicago, contends that it is illegal for HHS to refuse to reimburse hospitals in cases where auditors determine that inpatient care should have been provided on an outpatient basis.

 AHA President and CEO Richard Umbdenstock in a news release (PDF) said “What the federal government is doing is wrong, unfair and a clear violation of federal law. 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 noted that HHS officials were not disagreeing with the fact that patients were being delivered needed services but said hospitals should be reimbursed the outpatient rate at the very least and not be completely denied payment. 

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Monique Bryher, MSPH
Physician Real Estate Specialist
Physician Relocation Specialist
Physician Realtor®
Los Angeles

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