[ Monday, March 25, 2002 ]


Semi-OT (off topic): HCA execs cleared. The New York Times reports (link requires registration, but it's free, so go ahead and do it) that the 11th Circuit Court of Appeals has overturned the convictions of 2 HCA senior executives for making false claims against the Medicare program, because the government failed to prove that the statements were knowing and willfully false. The execs allegedly included items in capital cost reports that should've been in administrative costs; you get better reimbursement on capital costs that administrative costs. Part of the evidence was the plethora of alternative cost reports drawn up by the accountants, which the government used to "prove" the HCA guys were lying. Unfortunately, that didn't prove anything. Everyone draws up best-case and worst-case forms before submitting them, just to see where you'll be. Also, everyone knew the way the system worked: if a provider doesn't ask for something on their initial cost report, they'll never get a chance to ask for it again. You give the intermediary your best case, they tell you what they'll take, and you negotiate from there (if you can't get a deal, you end up at the Provider Reimbursement Review Board, or PRRB). There are always some items that could be characterized one way or another (the expense might be part capital and part administrative), so it's not always cut and dried. These guys just got to be the subject of the government's object lesson.

Jeff [9:13 AM]

Comments: Post a Comment
http://www.blogger.com/template-edit.g?blogID=3380636 Blogger: HIPAA Blog - Edit your Template