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3 hours ago
On Friday, a group of three hospitals filed a case in District of Columbia District Court against the Department of Health and Human Services. The suit alleged systemic underpayment of inpatient stays by Medicare according to the Inpatient Prospective Payment System (IPPS).
According to the complaint, filed by Sharp Chula Vista Medical Center, Grossmont Hospital, and Sharp Memorial Hospital, the IPPS reimburses hospitals according to a formula that determines reimbursement without regard to the amount the facility actually charges for the service. The formula includes factors such as a preset difficulty level or Diagnosis Related Group, a base line cost factor, adjustments for cost of living in the area where the hospital is located, modifiers for teaching facilities, and other factors, resulting in a payment that can be reasonable for the average patient.