The American Hospital Association says that overbearing regulation and an overly aggressive Dept. of Justice is hurting the hospital industry.
In a Jan. 14 letter written to Rep. Darrell Issa (R-Calif.), the new chairman of the Committee on Oversight and Government Reform, AHA president Rich Umbdenstock wrote that, “existing and proposed regulations that have negatively impacted the hospital field. Regulatory relief is of great importance to our members and one of our major legislative priorities this year.”
In particular, Umbdenstock wrote that anti-kickback provisions had “been stretched to cover any financial relationship between hospitals and doctors.”
“Congress, recognizing that the anti-kickback statute sometimes thwarts good medical practices, periodically has created ‘safe harbors’ to protect those practices. However, there is no safe harbor for clinical integration programs that reward physicians for improving quality. Congress should create a safe harbor to allow all types of hospitals to participate in clinical integration programs, establish core requirements to ensure the program’s protection from anti-kickback charges, and allow flexibility in meeting those requirements so that the programs can achieve their health care goals,” he wrote.
In addition, the AHA chief accused the DOJ and “certain Assistant United States Attorneys” of abusing the False Claims Act.
“These government officials have seized upon data analysis that flags billing errors and/or over-utilization and converted it into a presumption of FCA liability. FCA cases pose great risk to hospitals in terms of monetary and administrative sanctions. The threat of FCA liability leads hospitals to incur massive expenses related to retaining specialized counsel and outside forensic accountants and, in the event an overpayment is discovered, to negotiate a formal FCA settlement where a simple cost report adjustment is all that is really necessary,” he wrote.
The AHA represents approximately 5,000 members in the U.S.