OIG Recommends That CMS Review Critical Access Hospitals For Compliance With Medicare Enrollment Requirements

The Office of Inspector General (OIG) issued a report on August 15, 2013 in which the OIG concluded that two-thirds or 856 of the Medicare enrolled Critical Access Hospitals (CAHs) did not meet the location and distance requirements for a hospital to be enrolled with Medicare as a CAH. Hospitals can be certified as CAHs if they meet various regulatory requirements, including being located at least a certain driving distance from other hospitals and being located in rural areas. Medicare reimburses CAHs at 101 percent of their reasonable cost.

The OIG also commented that if CMS had decertified CAHs that were 15 or fewer miles from their nearest hospitals in 2011, the Medicare program would have saved $449 million. The OIG recommended that CMS take several actions to ensure a hospital’s compliance with the CAH requirements, including that CMS periodically reassess CAHs for compliance with all location-related requirements.

A copy of the OIG this report, “Most Critical Access Hospitals Would Not Meet the Location Requirements if Required to Re-enroll in Medicare” is posted on the OIG website at http://OIG.hhs.gov/ under the “What’s New” tab.

Written by: Clay Countryman
Clay Countryman_cropped

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