|To:||Allied Association Legal Counsel and V.P. Finance|
|From:||John E. Steiner, Jr.
American Hospital Association
Office of the General Counsel
|Subject:||Department of Justice/Office of Inspector General
DRG 72 Hour "Window" Project
UPDATE NUMBER 3
|Date:||April 4, 1996|
This is a brief status report on this national project based on recent conversations between our office and the Department of Justice, Harrisburg, PA office. The Assistant United States Attorney (AUSA) responsible for this project confirmed the following during a March 11, 1996 call:
Hospitals in the following states should expect letters from the Department of Justice by late summer (the Department of Justice could not be more specific):
*Texas *Wisconsin *North Carolina *South Carolina *Tennessee
*California -- The Department of Justice divides California into four districts. The DRG "Window" Project may already have started in one or more of these districts. It is our understanding that efforts to coordinate between the Harrisburg, Pa. AUSA's office and respective AUSAs' California offices may be causing delays.
Hospitals with low claims data and/or in bankruptcy
*The Department of Justice informed us that hospitals with less than $1,000 in duplicate paid claims, as projected through 1995, will receive a letter allowing the hospital to settle by repaying the amount stated in the letter, which represents duplicate paid claims plus interest, without entering into a formal compliance plan.
*The Department of Justice also confirmed that recoveries are not pursued against bankrupt hospitals when the Department of Justice receives confirmation that a hospital is in bankruptcy proceedings.
Current interpretive issues
Included in our February 27, 1996 memorandum to your office regarding this project was a letter to Dof J and OIG that raised concerns with the ambiguities associated with the phrases "an entity wholly owned or operated by the hospital" and "services related to the admission." See: 42 U.S.C. §1395ww(a)(4). It is our understanding that the Dof J, OIG and HCFA Central are examining these technical requirements of the statute and the rule in light of providers' concerns with government expectations of good faith compliance with the laws pursuant to Settlement Agreement.