Eli's Hospice Insider

Looks like hospices will be under heavy scrutiny for some time to come.

If you need a reminder of why your agency may be under the feds’ microscope, look no further than the HHS Office of Inspector General’s Semiannual Report to Congress.

“For every $1 invested in the Health Care Fraud and Abuse Control Program, we recovered more than $4 for taxpayers,” Inspector General Christi Grimm says in the new report to Congress covering October 2021 through March 2022. “We combated fraud through 320 criminal actions and $1.4 billion in expected investigative recoveries,” Grimm adds. “OIG is uncompromising in finding and prosecuting criminals who steal for personal gain at the expense of all Americans.”

The numbers show just how uncompromising. “OIG’s investigative work led to … 320 criminal actions during this reporting period,” the report highlights for lawmakers. “OIG also took civil actions, such as assessing monetary penalties against 320 individuals and entities, and excluded 1,043 individuals and entities from Federal health care programs.”

The report reviews fraud findings for all provider types. For hospice, the OIG reviews a February 2022 report in which it noted that “nonhospice payments for Medicare Part A services and Part B items and services totaled $6.6 billion from 2010 through 2019.” That’s an increase, and “suggest[s] the need for increased oversight,” the OIG tells Congress. “If providers bill Medicare for nonhospice items and services that potentially should be covered by hospices, Medicare could pay for the same items or services twice,” it warns. (See more details about the report in Hospice Insider, Vol. 15, No. 4.)

And in a November 2021 report, the OIG assessed that Medicare improperly paid Durable Medical Equipment, Prosthetics, Orthotics, and Supplies suppliers an estimated $117 million over four years for DMEPOS. In 121 of 200 sampled pieces of DMEPOS, the “items should have been provided directly by the hospices or under arrangements between the hospices and the suppliers,” the watchdog agency said. (See more details about the report in Hospice Insider, Vol. 15, No. 1.)

Note: The 93-page Semiannual Report is at https://oig.hhs.gov/reports-and-publications/archives/semiannual/2022/2022-spring-sar.pdf.