The AHA is complaining to federal regulators about overzealous enforcement of the False Claims Act in cases involving admissions for a spinal procedure, according to a report by AHA News Now.
The U.S. Attorney's Office for the Western District of New York has sent "contact" letters to hospitals that that do not appear to conform with Justice Department statements that the law should not apply to billing errors, mistakes and non-culpable overutilization, the AHA said.
The contact letters refer to inpatient admissions for kyphoplasty, a spinal procedure, even though a CMS guidance said admissions for kyphoplasty may be medically necessary and the letters do not indicate the Justice Department examined for medical necessity.
The department has "seized upon data analysis that flags billing errors and/or overutilization and converted it into a presumption of FCA liability," the AHA stated in a letter to HHS and the Justice Department.
"The threat of FCA liability leads hospitals to incur expenses related to retaining specialized counsel and outside forensics accountants and, in the event of an overpayment is discovered, to negotiate a formal FCA settlement where a simple cost report adjustment is all that is really necessary," the letter added.
Read the AHA News Now report on the False Claims Act.
Read more about the False Claims Act.
- 11 Things to Know About the False Claims Act
- Federal Officials Cite Record Number of Fraud Prosecutions, but See More to Do
- AHA Urges Supreme Court to Hear Case on False Claims Act
The U.S. Attorney's Office for the Western District of New York has sent "contact" letters to hospitals that that do not appear to conform with Justice Department statements that the law should not apply to billing errors, mistakes and non-culpable overutilization, the AHA said.
The contact letters refer to inpatient admissions for kyphoplasty, a spinal procedure, even though a CMS guidance said admissions for kyphoplasty may be medically necessary and the letters do not indicate the Justice Department examined for medical necessity.
The department has "seized upon data analysis that flags billing errors and/or overutilization and converted it into a presumption of FCA liability," the AHA stated in a letter to HHS and the Justice Department.
"The threat of FCA liability leads hospitals to incur expenses related to retaining specialized counsel and outside forensics accountants and, in the event of an overpayment is discovered, to negotiate a formal FCA settlement where a simple cost report adjustment is all that is really necessary," the letter added.
Read the AHA News Now report on the False Claims Act.
Read more about the False Claims Act.
- 11 Things to Know About the False Claims Act
- Federal Officials Cite Record Number of Fraud Prosecutions, but See More to Do
- AHA Urges Supreme Court to Hear Case on False Claims Act