Payment Matters

November 14, 2012

AHA and Hospitals Sue HHS Over Claims Denials Involving Patient Status

By: Leslie Demaree Goldsmith

In a suit recently filed [PDF] in the United States District Court for the District of Columbia, the American Hospital Association (AHA) and several hospitals, assert that the Medicare Program improperly denied payment to hospitals for reasonable and necessary services provided to hospital patients who Medicare contractors found were improperly admitted as hospital inpatients.The plaintiffs claim that these Medicare denials issued by Recovery Audit Contractors (RACs) are both procedurally and substantively flawed.

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