AHA: Medicare overpayment rule too burdensome for hospitals

A proposed rule under the Affordable Care Act for providers to report and repay Medicare overpayments is overly burdensome, the American Hospital Association told the Centers for Medicare & Medicaid Services yesterday.

In a letter to CMS, AHA said Section 6402(a) of the health reform law will have a "negative effect" on hospitals. With the 150 million claims that Medicare processes each year, there are bound to be mistakes by hospital staff, CMS staff and Medicare contractors, said AHA, which represents 5,000 member hospitals, health systems and other healthcare organizations.

"We viewed this provision in the ACA, and Congress intended it, as a means to correct mistakes," AHA wrote. "Instead, the law is being contorted by this proposed rule to create another confusing, onerous and legally risky set of expectations for hospitals."

As a result of the expanded False Claims Act in the Fraud Enforcement and Recovery Act of 2009, the healthcare law provision spelled out guidance to speed up the process of returning overpayments from the government.

AHA said the proposed rule places an "unreasonable emphasis on speed," leaving hospitals open to a false claims allegation if an overpayment is not returned within 60 days of receipt.  In addition, AHA said the 10-year look-back period, expanded from the normal four years, is "unreasonably burdensome" and "legally flawed." AHA also called on CMS to make clear that the final rule not apply to existing processes already in place to address overpayments.

"[T]he proposed rule will impose tremendous burdens on hospitals. The proposed rule fails to acknowledge the practice and administrative consequences of the new requirements, and the 'impact analysis' fails to recognize the compliance burden it creates," AHA wrote.

Public comment on the rule closed yesterday.

For more information:
- see the AHA News Now brief
- check out the letter (.pdf)
- see the proposed rule (.pdf)

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