Washington, DC – Representative James Lankford (R-OK) and Senator Tom Coburn, M.D. (R-OK) recently sent a letter to the Centers for Medicare and Medicaid Services (CMS) expressing concerns and asking for additional information regarding the problems four Oklahoma hospitals currently face with CMS’s Disproportionate Share Hospital (DSH) program.
CMS has recently asserted a claim for $250 million from four Oklahoma hospitals, citing past “overpayments.” CMS contends the hospitals were overpaid under the DSH program over a period of eight years (2006-present) despite the fact the hospitals were audited by a Medicare-approved contractor, also known as a “MAC,” for three out of the four years in question. A different MAC is now claiming the hospitals calculated the payments incorrectly, while the hospitals strongly disagree and assert they were previously cleared by the original audits.
“What Dr. Coburn and I are concerned about is the manner in which CMS handled the oversight of its contractors and the very long period of time it took to inform the hospitals of the issue,” said Lankford.
The former MAC audited the hospitals for the eight previous years and did not inform the hospitals in a timely manner of the payment discrepancies within the billing code structure for specific types of hospital beds. The second MAC waited until 2008 to tell the hospitals about payment discrepancies, and after the hospitals requested an impartial audit, the MAC audited itself and held the findings until January 2014. The hospitals are now on the hook for the eight-year period’s differences.
“Because CMS failed to catch these errors when they happened years ago, patients today will be forced pay the price. CMS owes Oklahomans an answer on how they plan to avoid high-cost issues like this in the future, and what steps the agency has taken to avoid a loss of services to patients in need. Health providers are already required to comply with mountains of paperwork, and Obamacare isn’t going to make that problem easier. We must make sure that our healthcare providers can maintain their acute focus on patient care, not just federal paperwork,” concluded Lankford.
For a copy of the letter, click here.