Home Health & Hospice Week

What's the status of your compliance plan?

Following VITAS' record-breaking fraud settlement, heed this advice from the experts to avoid being swept up in the feds' hospice dragnet.

• Consider compensation carefully. According to the feds, VITAS "set goals for the number of continuous home care days billed to Medicare and used aggressive marketing tactics and pressured staff to increase the volume of continuous home care claims, without regard to whether the patients actually required this level of crisis care," the Department of Justice says in a release.

VITAS also "rewarded employees with bonuses for the number of patients receiving hospice services, without regard to whether they were actually terminally ill and whether they would have benefited from continuing curative care," the government alleged.

"Setting goals for any level of care and then backing into them, so to speak, should be avoided at all costs," warns Washington, D.C.-based healthcare attorney Elizabeth Hogue. "This is especially true in view of the skills, proficiency, and drive of some marketing staff. Give them a goal of the amount of continuous care to be provided, for example, and they will go for it whether appropriate or not." Likewise, "pressure on clinicians to meet such goals is also inappropriate," Hogue adds.

• Know your risk profile. More and more, authorities are using your own billing data to single you out for scrutiny. If your agency's length of stay stats make you stand out from your peers, don't be surprised to find yourself the object of medical review scrutiny, fraud contractor examination, whistleblower lawsuits, or more.

Even just a few years ago, outlier LOS stats may have earned you some extra audit attention and a possible payback, observes attorney Robert Markette Jr. with Hall Render in Indianapolis. Now, it could result in a punishing fraud settlement like VITAS'.

"Understand your own numbers," Markette urges. Pay particular attention to benchmarking against providers in your own geographic area, he adds.

• Shore up your documentation. Having longer-stay patients than your peers or more on a higher payment level doesn't necessarily mean they are ineligible for hospice or that service level, Markette points out. You just must be very careful to make sure you have thorough and complete documentation that backs up your claims.

In the past, the patient's agreement to forego curative care was considered enough of a barrier to gaming the system, that reviewers often gave records, patients, and hospices the benefit of the doubt, Markette says. That practice continues no longer.

Instead of assuming reviewers will know the care is justified, clinicians must be very careful to spell everything out in the chart, Markette advises. Staffers must learn how to articulate all relevant facts and conclusions in the patient record. "The government will second-guess you," he warns.

• Prioritize compliance. "What does your compliance program look like now?" Markette asks. Dusting off your unused compliance plan when surveyors hit the doorstep, auditors request claims documentation, or you get served with a whistleblower lawsuit will be too late, he emphasizes.

Resource: See the HHS Office of Inspector General's compliance guidance for hospices at https://oig.hhs.gov/authorities/docs/hospicx.pdf.