AHA: IRF report ‘prime example’ of concerns with OIG audit reports

A recent Department of Health and Human Services Office of Inspector General audit report on 2013 inpatient rehabilitation facility stays “is a prime example” of the AHA’s ongoing concerns with OIG audit reports targeting potential Medicare overpayments to hospitals, the association told the agency today. “[W]e believe that the inability of IRFs to challenge the OIG’s findings (first directly with the OIG at the end of the audit and then through the appeals process) before the report was issued allowed the OIG grossly to overestimate the number of IRF claims that should not have been paid as well as the total overpayment for 2013,” AHA wrote. “…The AHA is confident that a very large proportion of the 175 claims the OIG said should have been denied would have been reversed on appeal had the providers been able to challenge them. And the OIG’s sampling and extrapolation methodologies also may have been called into question.” Among other concerns, AHA said the report’s “errors may discourage Medicare beneficiaries from seeking needed and valuable IRF care, waste scarce IRF and government resources and unfairly damage IRFs’ reputations.”