Oct 28, 2021

Schenck Price Successfully Defends Hospital Against Managed Care Company's Audit of Maternity Claims

On behalf of one of Schenck Price’s hospital clients, Brian Foley, Co-Chair of the Health Care Law Practice Group, successfully defended an audit by one of the leading Managed Care Organizations (“MCO”).

The MCO audited the hospital’s maternity claims and recouped payments.  The MCO’s stated reason for doing so was that the hospital did not obtain authorization for the services.

Foley appealed and defended the hospital’s claims on the basis that authorization is not required for maternity services provided by the hospital within the average length of stay. 

Since all of the claims were related to  maternity services rendered within the average length of stay, Foley was able to overturn the MCO’s recoupment, and recovered a six-figure payment for the hospital from the MCO.