Health Information Management

AHA loses lawsuit over Recovery Auditor appeals

HIM-HIPAA Insider, January 12, 2015

Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

The District of Columbia federal district court dismissed a lawsuit December 18, 2014, filed by the American Hospital Association (AHA) against HHS for excessive and inappropriate Recovery Auditor denials, according to AHA News.The AHA announced that it may appeal the court’s decision.

AHA fought back against the HHS’ December 2013 decision to suspend the assignment of Administrative Law Judges (ALJ) to appeals hearings. This suspension not only contradicts the requirement that the ALJ review an appeal and issue a decision within 90 days, but created an appeals backlog.
U.S. District Court Judge James E. Boasberg dismissed the lawsuit because he believed courts should not intervene in the Recovery Auditor appeals process at a time when HHS and Congress are working toward a solution to the appeals delay. In addition, Judge Boasberg ruled that the delay is not so outstanding that it requires judicial intervention, according AHA News.
Baxter Regional Medical Center in Mountain Home, Arkansas; Covenant Health in Knoxville, Tennessee; and Rutland (Vermont) Regional Medical Center joined AHA in filing the suit. When the lawsuit was filed in May 2014, the three covered entities had more than $8.9 million in combined pending Recovery Auditor appeals, AHA News reported.

Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • Medicare Audits in Long-Term Care: A Guide to MACs, RACs, and ZPICs

    This book describes the different types of Medicare audits that nursing homes face and helps you take a proactive approach...

Most Popular