Medicare auditor still paid millions despite reversals

Increasingly, it's looking like rehab hospitals dogged by Medicare auditor PRG-Schultz are going to get money back, thanks to new rulings by administrative law judges. The auditor, which has been accused of rejecting Medicare claims from rehab hospitals en masse, has faced tremendous criticism from the industry.

Now, after hitting a third level of reviews, hospitals are beginning to win reversals of the auditors' decision. However, despite the reversals, PRG-Schultz will still get paid the 25 to 30 cents per dollar it is typically paid in many cases. That's because the company's agreement allows it to get paid if its findings pass the first two levels of administrative review.

Lawyers for the 74 California rehab hospitals affected contend that these findings are likely to spell an end to the CMS-backed review program, which has been rejecting virtually all claims for patients admitted after knee and hip replacement surgery, as well as starting to deny rehab hospital claims for stroke services.

To learn more about the situation:
- read this McClatchy Newspapers piece [1]

Related Articles:
Lawmakers question California Medicare audits. Report [2]
California Hospital Association wants audit of auditor. Report [3]