“Finally Friday!” Hospital Appeals Settlements and OIG Work Plan Woes

FRIDAY November 11, 2016:

“Hospital Appeals Settlements
and OIG Work Plan Woes”

or How The Appeals Settlement reminds me
of the $5 scam from the movie “Paper Moon”

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Sponsored by The Health Law Partners, MAS Coding Solutions

THIS WEEK, we do a quick review of two huge topics: the “new” Hospital Appeals Settlement – reopened just recently – and the newly posted OIG Work Plan for FY2017.

Now, the funny thing to me is how CMS decided to “reopen” the 2014 Hospital Appeals Settlement Process (no longer being called the Global Settlement Process), as a response to a Federal Judge’s order to meet the statutory deadline for processing Medicare claims appeals, in AHA v. Burwell. I’m fairly sure CMS would never have agreed to do so except for the heat coming from the Judge.

A flim-flam man cons a clerk out of money and her product, too. Remind you of anything?

A flim-flam man (Ryan O’Neal in “Paper Moon“) cons a clerk out of money and her product, too. Remind you of anything?

But the other funny thing to me is how much the settlement smacks – again, in my opinion – of a scam. It made me think of the scam seen in the movie “Paper Moon.” A man walks up to a dime store counter, buys an item costing less than $1, paying with a $5 bill. But by the time he walks away from the clerk, he’s turned the $5 bill into a $10 bill, and the clerk is actually $5 short in the till. Anyway, perhaps the analogy doesn’t fit exactly, but if I were a hospital, offered this “new” settlement, I’d feel cheated, just the same.

So… join us as we will be discussing two topics (HASP & OIG):

  • WHAT is the 2016 Hospital Appeals Settlement Program?
  • HOW does the program work, and is it different than before?
  • HOW much is the settlement percentage THIS time?
  • WHAT kind of denied claims are eligible this time?
  • WHY would a hospital choose to participate?
  • WHAT should you be considering before you decide?
  • WHAT are some of the exciting highlights from the OIG?

So join us, share your own insights and bring your questions for us!

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Handouts for This Show


HHS OIG Work Plan 2017 Slides 7.64 MB 56 downloads



FAQs HASP 2016 167.82 KB 35 downloads



FAQs HASP 2016 [Ernie's Highlights] 223.64 KB 32 downloads


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