Hello Colleagues and Guests,
The American Hospital Association and four hospitals filed a federal
lawsuit against Kathleen Sebelius, Secretary of Health and Human
Services in her capacity as Secretary. I believe you may want to read
this suit. It can be found on the /oandpsolutions.org website, under
documents and then under lawsuits/.
In a nutshell, the RAC auditors are “clawing back” Medicare money from
hospitals regarding inpatient and outpatient claims. Some of these
claims go back several months and include prior years as well. We are
also talking about a huge sum of money. You can read the document for
yourselves. It is a very “eye opening” document and was filed before the
election. As you will see, the RAC auditors get a 12.5% fee for dollars
collected and, as in our case, the auditors and Medicare seem to be
violating federal statutes, as well as CMS policies and regulations.
Eventually, the you-know-what is going to hit the fan, one way or the
other. Right now, we are on the wrong side of the fan and the hospitals
evidently are as well. Even though we are likely at the very tail end of
a very long line, this lawsuit should give us hope that someone is going
to be forced to take notice of the inappropriate RAC auditing decisions,
whether they want to or not.
Wil Haines, CPO
Avon, IN 46123