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Increased Medicare Oversight of Hospice Providers May Be on the Horizon

In a July 2019 report, HHS’s Office of Inspector General (OIG) issued a report urging the Centers for Medicare and Medicaid Services (CMS) to increase its oversight of hospice providers. The OIG noted its own existing initiatives related to hospice fraud and abuse, ineligible patient enrollment, altered patient medical records, falsified documentation, and improper billing. The OIG’s report is a result of a survey of 4,563 hospices between 2012 and 2016.

Generally, to be eligible for Medicare-reimbursed hospice case, the beneficiary must be entitled to Medicare Part A and be certified as having a terminal illness with no more than a six-month life expectancy if the illness runs its normal course. The number of hospice beneficiaries has grown every year over the past decade. Besides an increase in beneficiaries, Medicare spent about 28% more for hospice care per beneficiary in 2017, as compared with 2006.

The increase in beneficiaries and spending, however, has not necessarily resulted in better care or increased oversight, according to the OIG. The OIG noted that deficiencies increased from 72 to 294 between 2012 and 2015, an approximately 294% increase. The OIG “identified significant vulnerabilities in the Medicare hospice benefit” program. For example, many hospices failed to vet their staff or perform background checks. According to the OIG report, inappropriate billing by hospices has resulted in Medicare losing millions of dollars, and some hospice providers bill Medicare for a higher level of care than required by the beneficiary. In addition to billing and regulatory concerns, the OIG focused heavily on patient care. The OIG found that 87% of hospice providers had at least one deficiency, and that one-third of hospices had complaints filed against it, with one-third of those complaints substantiated.

Based on its findings, the OIG recommended that CMS strengthen its hospice survey process, seek statutory authority to include information from accrediting organizations on Hospice Compare, as well as expanding and using deficiency data in order to increase hospice oversight. In response, CMS concurred (or at least partially concurred) with all but one of the OIG’s recommendations. While the OIG’s findings alone are enough to draw increased attention to hospice providers, coupled with the OIG’s recommendations, the OIG’s report may very well spark increased scrutiny related to hospice complaints, deficiencies, and billing practices.

The attorneys at CCLB have represented numerous hospice providers in connection with regulatory, compliance, and litigation matters. If you have any questions related to such matters, please call us at (404) 262-6505.