Saying that hospitals and doctors are being “second-guessed” about treatment decisions by government-sponsored recovery audit contractors, the American Hospital Association today filed suit against the U.S. Department of Health and Human Services (HHS) for what the association said was refusal to “meet its financial obligations for hospital services provided to some Medicare patients.”

Four hospital systems, including those in Michigan, Missouri, and Pennsylvania, joined in the suit that accuses HHS of refusing to reimburse hospitals for what it described as “reasonable and necessary care” when the recovery auditors believed that inpatient care should have been provided in an outpatient setting.

“What the federal government is doing is wrong, unfair, and a clear violation of federal law,” said Rich Umbdenstock, president and CEO of the AHA, in a news release issued today and posted on the AHA’s website. “Doctors and nurses provide the best care possible using their medical judgment and training. 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.”

More details to follow at RACmonitor.


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