OIG Once Again Calls for Review of CAH Criteria

October 19, 2014
Rick Gawenda

The Office of the Inspector General (OIG) is once again calling for a review of critical access hospital (CAH) criteria for hundreds of small rural hospitals across the nation. The OIG released another report this month revealing that Medicare beneficiaries pay more for outpatient services at critical access hospitals than they would at an acute care hospital for the same services. The OIG found the following:

Because coinsurance amounts were based on charges, Medicare beneficiaries paid nearly half the costs for outpatient services at CAHs. In 2012, beneficiaries paid approximately $1.5 billion of the estimated $3.2 billion cost for CAH outpatient services.

The average percentage of costs that beneficiaries paid in coinsurance for these services increased2 percentage points between 2009 and 2012.

For 10 outpatient services that were frequently provided at CAHs, beneficiaries paid between 2 and 6 times the amount in coinsurance than they would have for the same service at acute care hospitals.

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